NEDIC Conference Journal 2018

nediccanada

ISSN 2562-1513

Key title: The Journal of the National Eating Disorder Information Centre

Copyright 2018 by NEDIC. All rights reserved.

Published by Fireside Publishing 2018

Lindsay, ON

No part of this book may be used or reproduced in any manner whatsoever without the prior written permission

of the publisher, except in the case of brief quotations embodied in reviews


Words of Welcome

We are very excited to share the inaugural Journal of the National Eating Disorder Information Centre. This journal

is borne out of our desire to provide information that is research-based, evidence-based, and it represents best

practice. We want the journal to share new information from the field, build community and move the

conversation forward.

Our inaugural journal was by invitation only. The papers that appear in this journal reflect work presented by the

authors at our 2017 body image and self-esteem conference: Acceptance. Equity. Awareness. Our hope for this

journal is to enrich the conference presentations for conference delegates, refresh memories, and share exciting

new research and ideas with those not in attendance. We are proud that this journal champions the work of

Canadian researchers working tirelessly in the field of eating disorders and body image in order to improve the

lives of individuals and shed light on these often misunderstood and under-researched disorders. We hope that

the papers in this journal provide you with insight and information that you can utilize in your professional

practice, interpersonally, or even in your own life.

Our 7th biennial conference: Radical Unlearning is being held May 9-10, 2019 at the University of Toronto’s

Chestnut Conference Centre.

We look forward to seeing you at our 7th biennial conference and to the articles that we will consequently publish

in our 2020 Journal. The theme of Radical Unlearning incorporates equity, innovation and positive body

identity. The term “unlearning” allows those who are learning to navigate new ideas and norms in a nonjudgmental,

compassionate manner. We hope this will be an opportunity to learn – and unlearn – collaboratively,

and to unpack the negative and erroneous messaging that individuals may have received.

Sincerely,

Suzanne Phillips, Program Manager, NEDIC


Acceptance, Equity and Awareness: Introduction to Edition 1 of The NEDIC Journal

Lorayne Robertson and Joli-Scheidler-Benns

We have argued for many years that body equity is one missing aspect of an inclusive nation. When Canadians

speak about inclusion, they generally consider first the well-established grounds for discrimination from The

Canadian Charter of Rights and Freedoms. Yet areas of inclusion continue to emerge in our society and need to be

recognized in research and in thoughtful discourse. Canadians are naturally diverse in body sizes and shape, as well

as their physical abilities, and the ways that they want to be active. In Canada, people have a right to “be” that

includes every aspect of their personhood. A body-equity approach includes everyone in a diverse population and

speaks against body-based bias, prejudice and discrimination.

We would encourage readers of this journal to embrace the theme of the 2017 conference “Acceptance, Equity

and Awareness” and think beyond discrimination. Consider the possibility of how bodies of all sizes, shapes,

genders, colours and abilities are not only accepted but celebrated and normalized in discourse, in media and in

prevention and treatment. As we become more inclusive as a nation, we will develop more individualized and

personalized approaches for all bodies and we will recognize that there is both discrimination and risk inherent in

many of society’s perfection codes.

As our awareness grows, we will shed the moral overtones that for generations have been associated with size and

acknowledge that health is not determined by size. Rather than attaching stigma to individuals, we need to

recognize as a society that there are broad systems that determine access to nutrition, exercise and health

supports.

As the editors of this inaugural journal, we are proud to support the Canadian authors who support inclusion and

equity. In the first article, Margo Maine explains that the majority of women at midlife are preoccupied with

weight and distress over their shape, appearance and diet. She presents Nine Truths about Eating Disorders at

Midlife and Beyond. She urges the same type of compassion for eating disorders as that with which we would

approach breast cancer or any public health problem.

In the second article, Niva Piran theorizes the societal structures of privilege and powers that are connected with

living in our bodies in Privilege and the Body. She presents the Developmental Theory of Embodiment as a lens

that can be used to examine, for example, social stereotypes and social power and their relationship to

embodiment. In the third article, Booty Shorts and Sexting, Angela Grace examines two case studies and then

applies Piran’s theory of embodiment in order to identify the social justice issues such as silencing and create an

action plan that includes empowerment.

Aligning with the themes from this conference, Andrea LaMarre and Kaley Roosen (Navigating Differences within

Eating Disorders and “The Other”) challenge us to consider that conversations about eating disorders which

continue to carry assumptions that limit our capacity to engage in deeper ways with persons who struggle. They

offer a model of compassionate care that recognizes systemic problem relationships. They encourage us, instead,

to look to ways to engage with diversely embodied persons with eating disorders.

The fifth paper in the journal informs readers about another equity-conscious and caring treatment approach, Ann

McConkey and Lisa Naylor from the Women’s Health Clinic in Winnipeg present A Weight-Neutral Approach to

Health and Wellness. As HAES® practitioners, their emphasis is on health-promoting behaviours and changes to

improve the quality of life for persons of all shapes and sizes.

The journal closes with two papers that focus on prevention. In Adolescent Girls Use Power Tools, we report

research that was designed to build protective factors for adolescent girls who explore critical media literacy and

health. Joli Scheidler-Benns has designed a critical media health literacy framework that helped to examine

whether or not adolescent girls could learn to think more critically through a program of body positive activities. In

the final paper, Learning about Real, Lorayne Robertson explores the intersections between critical media literacy

and body equity. She argues that students who are exposed to more critical forms of literacy can recognize and


espond to media that promote stigma and stereotypes. She holds out hope that today’s adolescents can rewrite

media scripts to promote body-fair messages.

We hope that readers of the inaugural journal will experience a flood of memories from the 2017 conference. We

believe in the platform of an open journal and we encourage readers to share articles broadly in support of the

goals of NEDIC.

Lorayne Robertson and Joli Scheidler-Benns

Editors, The Journal of the National Eating Disorder Information Centre


Table of Contents

Nine Truths about Eating Disorders at Midlife and Beyond, Margo Maine 1-5

Privilege and the Body: The Role of Critical Awareness to Enhancing Positive Embodiment, Niva

Piran

6-10

Booty Shorts and Sexting: A Social Justice Approach to Body Image and Self-Esteem, Angela Grace 11-17

Navigating Differences Within Eating Disorders and “The Other”: What the Professional Brings

and What They Leave Behind, Andrea LaMarre & Kaley Roosen

18-24

A Weight Neutral Approach to Health and Wellness, Ann McConkey and Lisa Naylor 25-31

Adolescent girls use power tools: A critical media health literacy program, Joli Scheidler-Benns

and Lorayne Robertson

32-37

Learning about Real: Critical Media Literacy and Body Equity, Lorayne Robertson 38-43


Nine Truths about Eating Disorders at Midlife and Beyond

Margo Maine, PhD, FAED, CEDS

Maine & Weinstein Specialty Group, West Hartford, CT USA MDM@mwsg.org

Abstract

Age does not immunize women from eating

disorders. In fact, increasing numbers of midlife and

older women are seeking eating disorders treatment,

despite prevailing beliefs that these conditions only

affect the young. Body satisfaction used to increase

with age, but today the majority of midlife

women express significant weight preoccupation and

distress over their shape, appearance, and diet,

threatening the health, well-being, and status of

women across the globe. Inspired by the Academy

for Eating Disorders Nine Truths About Eating

Disorders, this paper presents Nine Truths About

Eating Disorders At Midlife and Beyond and

introduces Relational Cultural Theory as a treatment

approach. Eating disorders are a life-threatening and

treatable disease, not a character flaw or a cosmetic

issue. We must approach eating disorders affecting

women in midlife and beyond just as openly,

seriously, and compassionately as we approach

breast cancer and other public health problems.

1. Introduction

Not so long ago, age seemed to immunize adult

women from the body image, weight issues, and

eating disorders that plague the younger years.

Although most cases still appear in adolescent girls

and young women, an alarming shift is occurring.

Flanked by Spanx and Botox, eating disorders are

on the rise among middle-aged and older women. In

fact, inpatient admissions between 1999 and 2009 in

the US showed the greatest increase in this group,

with women over age 45 accounting for a full 25% of

those admissions [1]. Some adult women have

suffered eating disorders throughout their lives.

Others had a clinical eating disorder when younger

and recovered partially or fully, relapsing in midlife,

or were subclinical but able to control their

symptoms until midlife. A small number develop

eating disorders for the first time as adults. Inspired

by the Academy for Eating Disorders Nine Truths

About Eating Disorders [2], in the next section I

examine these truths at midlife.

2. Nine truths about eating disorders at

midlife and beyond

Truth #1.

Eating disorders in women at and beyond midlife

are now a major public health problem, rivaling the

frequency of other serious illnesses. While 12.4% of

US women have breast cancer [3}, 13.3% of US

women 50 and older report eating disorder

symptoms [4]. The lifetime prevalence of eating

disorders in a UK community sample was as high as

15.3% of midlife women, with Other Specified

Feeding and Eating Disorders (OSFED) the most

prevalent. Only 27.4% in this study sought help or

received any treatment for the eating disorder [5].

Truth #2.

Eating Disorders are multidetermined

biopsychosocial disorders. Genes create

vulnerabilities to be tempered or intensified by other

factors, including the environment, early

development, physical conditions, and social

experiences or expectations [6]. Eating disorders still

occur disproportionately in women so gender is the

greatest risk factor [7]. The shared heritable

environment includes toxic intergenerational

attitudes toward, weight, food, and body image that

contribute to disordered eating.

Truth #3.

Now globalized, eating disorders are found on all

continents, increasing across Asia and Arab countries

and in a broad range of cultural, racial and ethnic

populations {8]. Our world is in transition, and

women, therefore, are in transition. This new

cultural context includes: exposure to the “war on

obesity,” weight bias, and the misinformation

promulgated by the diet industry; an overpowering

consumer culture with constant exposure to strict

and unrealistic media images of beauty; shifting

gender roles due to industrialization, urbanization,

and modernization; and the trend toward highly

1


palatable prepared and fast foods and the adoption

of a more sedentary lifestyle, contributing to

increased BMIs and eating issues. As Christiane

Northrup, a holistic physician, asserts: “The state of a

woman’s health is indeed completely tied up with

the culture in which she lives and her position within

it” [9}. Contemporary globalized consumer culture

clearly creates risk for women.

Truth #4.

Age does not immunize women from body image

preoccupation and eating disorders. Disordered

eating and a fear of aging appear to go hand-in hand

for many women [10], with weight cited as the

greatest bodily concern in a study of women aged 61

to 92 [11]. Disordered eating is common and equally

frequent in African American, Hispanic, and

Caucasian women aged 42-55 [12]. Similar patterns

are found in other countries. For example, while

4.6% of Austrian women aged 40-60 met the full

criteria for a clinical eating disorder, another 4.8%

met the subthreshold standards. However, both

groups report the same degree of psychopathology,

distress, and impairment, suggesting that we must

take subclinical eating disorders as seriously as full

spectrum [13].

Truth #5.

Clear differences appear when comparing eating

disorders in adult women with the younger

population [14]. Older women tend to experience

significant shame for having a “teenager’s problem”

and greater difficulty admitting the need for help,

having invested more years speaking the language of

fat. They often have a painful awareness of what

they have lost in their relationships and in health.

Their motivation for treatment is also different as

they may be concerned about the impact of their

eating disorder on their children and hope not to

pass it down to them. Adult women definitely

experience more obstacles to treatment due to

other responsibilities, including their families, their

jobs, and their roles in their communities. Just as

with younger women, developmental transitions

place midlife and older women at risk for disordered

eating and body image issues. These include

increased anxiety about appearance and health due

to the natural aging process, the loss of power and

status as woman age, and multiple stressors and

losses that accompany adult development.

Truth # 6.

Relational Cultural Theory (RCT) provides an

effective therapeutic framework for the treatment of

eating disorders [15]. RCT conceptualizes eating

disorders as disorders of disconnection that begin as

self-protection when relationships are challenged.

Despite wanting a relationship, women use eating

disorder symptoms to maintain emotional safety and

distance. Over time, the relationship with the eating

disorder replaces and competes with true relational

possibilities [16]. The relational model challenges the

eating disorder by offering growth-fostering

relationships based in connection and mutuality.

Instead of the “power over” medical model of

traditional treatment, RCT is a feminist framework

promoting a “power with” collaboration. Fluid

expertise, a core concept of RCT, refers to the shared

resources and insight that both the client and

clinician bring to the treatment experience. The

primary therapeutic tool is mutual empathy [17].

Truth #7.

The most current findings in neuroscience uphold

the basic tenets of the relational model [18].

Neuroscience has taught us that the human brain is

“hardwired to connect,” and that isolation actually

causes the human brain to atrophy. Similarly, RCT

challenges the paradigm of the separate self in

traditional psychological theories and views isolation

as the major source of suffering for people. Eating

disorders are strategies of disconnection from

interpersonal pain. Recovery requires reconnection

in healthy relationships that provide mutual growth.

Truth #8.

When it comes to medical issues, adult patients

suffer the same medical sequelae as younger

patients in that every system is affected by

malnutrition [19]. However, despite long-term

stability, medical complications can emerge quickly

in older patients. Adult women also experience some

unique issues medically. For example, depleted fat

stores will likely increase menopausal symptoms and

muscle-wasting can reduce metabolic rate and

hasten neuromuscular decline. In elderly, dieting is

especially risky [20]. Cognitive impairment secondary

to dieting may also be greater [21] and the mortality

risk associated with low weight is greater as people

age [22].

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Truth #9.

Psychoeducation is a powerful tool for the

treatment of eating disorders at midlife and beyond.

In RCT language, psychoeducation is effective

because it is a “power with” modality. By giving the

patient information to guide her decisions about

behavior change, it levels the power differential,

increases the mutuality of the clinical relationship,

and makes women more effective collaborators in

their care.

Most women in contemporary culture know

endless techniques to change their bodies to make

them look a certain way, but they know next to

nothing about the female body’s essential internal

processes. The truth is that the female body is

remarkably resilient, able not only to survive adverse

circumstances, but also to maintain the human race.

I usually introduce these facts to my patients as The

Magic of Women’s Bodies. I would like to call it

Facts, Fat, and Femininity, but most women would

stop listening at the word Fat. Yet fat is essential to

survival for women as individuals and for the survival

of the species.

3. The Magic of Women’s Bodies

Women’s bodies are hard wired to respond to

starvation. Only 10 % of women die in famine while

50% of men do! Our bodies are incredibly resilient

and designed to survive [23].

• Before puberty, a girl’s body has about 12 %

body fat. During puberty, fat cells multiply to make

up about 17 % of body composition - enough for

ovulation and menstruation. Our bodies need fat to

develop and survive.

• A mature woman’s body will have about

22% body fat- enough energy for an ovulating

female to survive famine for nine months [24]. In

other words, the human race survives because of the

adult woman’s natural resource –adequate body fat!

• Women gain fat first in the breasts,

buttocks, hips, and thighs to protect our fertility,

reproductive, and feeding organs. Once more, the

female body has innate survival skills

• During the transition through menopause,

women experience an average weight gain of 12-15

pounds, while metabolism slows 15-20% [25].

• During this transition, hormonal shifts

increase the size of fat cells surrounding our

reproductive organs as these produce estrogen,

offsetting the shutdown of the ovaries. This natural

process allows women to maintain bone density,

decrease the risk for osteoporosis, and manage

symptoms of menopause. The female body knows

how to take care of itself.

• Moderate weight gain at midlife is

associated with longer life expectancy for women!

[25,26]

4. Conclusion

These important and empowering facts can help

women to make peace with their bodies and to

accept the female body’s inherent wisdom. For

example, I shared these facts with a woman who

came to me in her early 70s for assessment of her

eating and body image issues. Returning the next

week, she hesitated before sitting down, proudly

announcing: “I used to see this roll around my

middle as my spare tire and I hated it. Now I see it as

my life preserver!” She is absolutely correct.

Adequate body fat is a life preserver for women, but

the dieting industry does not want anyone to know

that.

Clearly, age does not decrease the risk for

developing an eating disorder. Eating disorders at

midlife and beyond must rank as a high priority on

our health care agenda. Medical providers, insurers,

and government agencies must learn about the

unique female physical and psychosocial experiences

that create risk for eating disorders throughout adult

development. Screening should be routine with

simple questions about weight fluctuations, dieting,

nutrition, body image, anxiety, and life stressors.

This is not just the job for pediatricians.

Obstetricians and gynecologists, family

practitioners, internists, and even geriatricians all

have a vital role in the fight against eating disorders.

Mental health clinicians and dietitians need to

collaborate with medical providers to develop

resources for these women. Given the competing

demands of their families, jobs, and financial

resources, adult women face multiple barriers to

treatment. We must make it easier for them to

access care.

Women also need to feel safe telling the stories

of their bodies [27]. Just like breast cancer, eating

disorders are a life-threatening and treatable

disease, not a character flaw. As a society, we all

have a role in addressing this critical public health

issue. It is time to approach eating disorders

affecting women in midlife and beyond just as

3


openly, seriously, and compassionately as we

approach breast cancer and other public health

problems.

5. References

[1] Zhao Y. and Encinosa.W. (2011). An Update on

hospitalizations for eating disorders, 1999 to 2009.

Healthcare Cost and Utilization Project (HCUP) Statistical

Brief #120. Rockville, MD: US Agency for Health Care Policy

and

Research.

[2] Academy for Eating Disorders. Nine Truths About

Eating Disorders. Accessed @

www.aedweb.org/learn/publications/nine-truths.

[3] American Cancer Society. Breast Cancer Facts & Figures

2017-2018. www.cancer.org.dam.research.

[4] Gagne, D. A., et al. (2012). Eating disorder symptoms

and weight and shape concerns in a large web-based

convenience sample of women ages 50 and above: Results

of the gender and body image (GABI) study.” International

Journal of Eating Disorders 45:7, 832-44.

[5]] Micali,N. et al, (2017). Lifetime and 12-month

prevalence of eating disorders amongst women in mid-life:

a population-based study of diagnoses and risk

factors.BMC Medicine 15:12. DOI 10.1186/s12916-016-

0766-4.

[6] Chavez, M., & Insel, T. R. (2007). Eating disorders:

National Institute of Mental Health’s perspective.

American Psychologist, 62 (3), 159- 166.

[7] Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors

for eating disorders. American Psychologist, 62(3), 181-

198.

[8] Pike, K. M., Hoek, H. W. & Dunne, P. E. 2014). Cultural

trends and eating disorders Curr Opin Psychiatry. 2014

Nov;27(6):436-42. doi: 10.1097/YCO.0000000000000100.

[9] Northrup, Christiane. Women's Bodies, Women's

Wisdom: Creating Physical and Emotional Health and

Healing. New York: Bantam Dell, 2006, p.xxxiv.

[10] Lewis, D.M. & Cachelin,F.M. (2001). Body image, body

dissatisfaction, and eating attitudes in midlife and elderly

women. Eating Disorders: The Journal of Treatment and

Prevention, 9, 29-39.

[11] Clarke, L. H. (2002). Older women’s perceptions of

ideal body weights: The tensions between health and

appearance motivations for weight loss. Ageing and

Society 22,751-73.

multiethnic community sample of midlife women. Annals

of Behavioral Medicine, 33, 269–277.

[13] Mangweth-Matzek, B., Hoek, H. W., Rupp, C. I.,

Lackner-Seifert, K., Frey, N., Whitworth, A., Pope, H. G., &

Kinzl, J. (2014). Prevalence of eating disorders in middleaged

women. International Journal of Eating Disorders 47,

(3), 320-4.

[14] Maine, M. & Kelly,J. (2016). Pursuing Perfection:

Eating Disorders, Body Myths, and Women at Midlife and

Beyond. New York: Routledge.

[15] Samuels, K. & Maine, M. (2012). Treating eating

disorders at midlife and beyond: Help, hope, and the

Relational Cultural Theory. Work in Progress: No. 110. Jean

Baker Miller Training Institute at the Wellesley Centers for

Women

[16] Tantillo, M. & Sanftner, J. (2010). Mutuality and

motivation in the treatment of eating disorders:

Connecting with patients and families for change. In M.

Maine, B. Mc Gilley & D. Bunnell (Eds.), Treatment of

eating disorders: Bridging the research - practice gap (pp.

319-334). London, UK: Elsevier.

[17] Jordan, J. (2010). Relational-Cultural Therapy.

Washington, DC: American Psychological Association.

[18] Banks, A. & Hirschman, L. a. (2015). Four ways to click:

rewire your brain for stronger, more rewarding

relationships. New York: Jeremy Tarcher/ Penguin

[19] Maine, M., Samuels, K., & Tantillo, M. (2015). Eating

disorders in adult women: Biopsychosocial,

developmental, and clinical considerations. Advances in

Eating Disorders: Theory, Research and Practice. (2015).

DOI: 10.1080/21662630.2014.999103.

[20] Gupta, M. A. )1995). Concerns about aging and a drive

for thinness: A factor in the biopsychosocial model of

eating disorders? International Journal of Eating Disorders,

18:4 ,351-57.

[21] Lewis, D. M., & Cachelin, F. M. (2001). Body image,

body dissatisfaction, and eating attitudes in midlife and

elderly women. Eating Disorders: The Journal of

Treatment and Prevention 9, 29-39.

[22] Miller, S. L. & Wolfe, R. R. (2008). The danger of

weight loss in the elderly. Journal of Nutrition, Health

&Aging, 12 (7), 487-91.

[23] Waterhouse, D. (2003). Outsmarting the Female Fat

Cell After Pregnancy New York: Hyperion.

[12] Marcus M. D., Bromberger J. T., Wei H.

L., Brown C., Kravitz H. M. (2007). Prevalence and selected

correlates of eating disorder symptoms among a

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[24] Waterhouse, D. (1997). Like Mother, Like Daughter:

How Women are Influenced by Their Mother's Relationship

with Food and How to Break the Cycle. New York:

Hyperion. Retrieved from www.34-menopausesymptoms.com/weight-gain.htm

(Retrieved August 12,

2015).

[25] Janssen,I., Katzmarzyk, P.T. & Ross, R. (2005).

"Body Mass Index Is Inversely Related to Mortality in

Older People After Adjustment for Waist Circumference."

Journal of the American Geriatrics Society, 53(12):2112-

2118. www.medscape.com/viewarticle/518415.

[26] Dolan, C. M., Kraemer, H., Browner,W., Ensrud, K. &

Kelsey, J. L. (2007) "Associations between body

composition, anthropometry, and mortality in women

aged 65 years and older." American Journal of Public

Health 97 (5), p. 918.

[27] Zerbe , K. J. (2013). Late life eating disorders. Eating

Disorders Review 24,(6): 3-5.

5


Privilege and the Body:

The role of Critical Awareness to Enhancing Positive Embodiment

Niva Piran, PhD

University of Toronto

Abstract

Societal structures of power and privilege

and individuals’ experiences of living in their bodies

are inextricably connected. Therefore, the complex

social processes that privilege some bodies and

disenfranchise others have to be understood in order

to engage in socially transformative initiatives that

can enhance positive embodiment. The

Developmental Theory of Embodiment provides a

lens through which to examine social processes that

either facilitate or disrupt embodiment. The paper, in

particular, examines expressions of privilege and

disenfranchisement in the physical, social

stereotypes, and social power and relational

connection domains and their relationships to

embodiment. It further suggests that interventions

that aim to enhance positive embodiment among

girls and women align with social justice, feminist,

anti-oppressive, and human rights goals.

1. Introduction

I got this tummy and I couldn’t fit into one

of my favorite pairs of pants. I had a dance and it

was like, “oh, my God, I have to fit into these pants.”

People talked behind my back and said how fat I was

and stuff. [Friend—a girl] is really overweight but it

does not bother her. She knows she can’t be teased

because she has a boyfriend and he has blond hair

and he is real cute, and he has blue eyes, crystal blue

eyes . . . Girls like a good blue-colored eyes. I know I

do and I think most girls do. Girls want to be really

skinny and to have a peach skin or blush . . . I wear

long sleeves and skirts cover the black hair on my

arms and legs . . . I was not in the popular class

anymore . . . I was in the dorks, second class . . .

Usually fat people are not in the popular group . . . I

felt like I was an outsider. I felt like an alien. I was

like, ‘I have to lose weight or else I’m gonna be living

on Mars for the rest of my life.’ [1, p. 98]

In this narrative, Jackie, an 11-year-old girl

of Aboriginal heritage and working class background

who participated in a prospective interview study

with girls, explained her embodied distress and

drastic weight loss (16% of her weight) at the onset

of puberty. At the intersection of classism (she could

not afford to buy another pair of favorite jeans),

weightism, racism, and sexism, Jackie felt that losing

weight was the only avenue she had to break

through her demoted social status. Jackie’s

experience exemplifies the inextricable connection

between societal structures of power and privilege

and individuals’ experiences of inhabiting their

bodies [2,3]. Clarifying the complex social processes

that privilege some bodies and disenfranchise others

underlies social transformations towards enhanced

social justice and individuals’ positive embodiment.

2. Theoretical Framework

In a recent book entitled, Journeys of

Embodiment at the Intersection of Body and Culture

[1], I outline the research-based Developmental

Theory of Embodiment (DTE), which describes

processes that socialize girls and women of different

backgrounds into inequity through targeting their

bodies. As the DTE suggests, the social processes

that shape embodiment take place at the physical,

social stereotypes, and social power domains (see

Figure 1 for a delineation of the theoretical

structure). This paper aims to delineate social

processes related to privilege and the body in these

three domains in order to inform social

transformations towards enhanced body equity.

6


eing. In particular, upon the onset of puberty girls’

and women’s experiences of active engagement in

the physical sphere becomes restricted due to

multiple factors, such as: the masculinization of

sports and restrictive norms of femininity, confining

and exposing clothing, the smaller allocation of

resources to girls and women’s sports, compromised

safety, and inequity in the domestic sphere [1,9]. As

Piran describes [1], living in financially challenged

circumstances or in unsafe neighborhoods further

limits opportunities for engagement in physical

activities and the freedom of movement in the

public sphere.

3. Privileges and Challenges in the Physical

Domain

Physical experiences are powerful in

shaping experiences of embodiment by affecting the

quality of connection and comfort in the body,

embodied agency, experience and expression of

desires, engagement in attuned care, and resistance

to self-objectification. The DTE highlights four key

experiences that affect embodiment in the physical

domain, that are, in turn affected by intersecting

dimensions of social privilege [1].

3.1. Safety versus violations to the

body territory

Violence takes places within the context of

inequity of power and privilege, leading to enhanced

powerlessness, shame, and multiple disruptions in

the body domain among victims. Sexual violations

are common among adolescent girls and women,

who, most commonly experience rape before age

18, with a lifetime prevalence rate of over 1 in 6

women [4]. This challenge is more severe among

specific groups of women, such as women of color

and members of indigenous communities in North

America [5], women who identify their sexual

orientation as lesbian, gay, bisexual, queer, or

questioning [6] or their gender identity as

transgender [7], and women living with physical

disability [8].

3.2. Freedom versus restriction to

physical engagement and movement.

Similar to the experience of safety, freedom

to physical engagement and movement in the public

sphere is granted to privileged members of society,

enhancing their embodied agency, joy and well

3.3 Sanctioning versus Vilification of

Desire

Connection, comfort, and agency in the

practice of desire enhance positive embodiment

[1,10]. However, women go through challenging

journeys connecting with their sexual desires and

commonly report difficulties in being attuned to

their desires and communicating their preferences

and boundaries in sexual practices [1,10]. Such

challenges relate to the lack of validation, and the

common vilification, of female desire [8,10,11],

sexual objectification and performance expectations

[12,13], the range of sexual violations [10], and the

practice of sexuality within the context of

inequitable power related to gender, class,

ethnicity/race, physical disability and other social

variables [14]. The experience and practice of sexual

desire among individuals who identify their sexual

orientation as lesbian, gay, bisexual, queer, or

questioning or their gender identity as transgender is

further oppressed along all these lines [8].

Connection to appetite is also commonly disrupted

among adolescent girls and women related to the

dictate that they restrict the physical space they

occupy in terms of size [1]. In homes where food

insecurity exists, connection to appetite is further

challenged [15].

3.4 The practice of care of the body

versus body neglect.

Greater opportunities to practice attuned

care of the body are more available to privileged

members of society. Adolescent girls and women

face multiple challenges in the physical care of their

bodies [1]. For example, adolescent girls and women

face little societal support in dealing with the

spectrum of sexual violations, the vilification of

female desire, menstruation, contraception,

7


domestic inequity, salary gap, and other challenges.

These challenges are greater for young women who

are poorer, heavier in weight, and whose

race/ethnicity, sexual orientation, gender identity,

and physical disability exposes them to greater

discrimination and fewer resources [1,8].

Enhancing positive embodiment relates to

social changes at all levels of the social environment

that attend to the physical experiences of diverse

girls and women.

4. Privileges and challenges in the mental

domain of internalized social stereotypes

Social stereotypes are powerful tools for

maintaining social inequities. For example, the

strong pressures on adolescent girls and women to

stay thin deprives them of the right to take space,

inhabit their bodies comfortably, and act with

embodied agency in the world [1]; internalizing such

pressures relate to negative body image and eating

disorders [16]. The DTE emphasizes the importance

of scrutinizing and altering multiple social

expectations that women face towards enhancing

positive embodiment.

4.1 Femininity-related stereotypes

Regarding femininity, the DTE highlights

both appearance-related and comportment-related

sets of expectations. Appearance-related

stereotypes, clustered under the ‘woman’s body as a

deficient object’ category [1], privilege men as the

holders of the objectifying gaze and compel women

to engage incessantly in body repair. Indeed,

internalizing an objectified gaze at one’s body, or

self-objectification, is related to body shame,

depression, disordered eating and sexual

dysfunction [17, 18, 19, 20]. Comportment-related

stereotypes, clustered by the DTE under the ‘woman

as docile category [1], involve the expectation that

adolescent girls and women act demure, submissive,

contained, and be other-attuned. Such disciplining of

women leads to the assigning of penalizing labels to

those who are perceived as not complying with the

‘woman as docile’ dictate by being assertive (labelled

as ‘bitch’, ‘aggressive’), self-attuned (labelled as

‘selfish’, ‘narcissistic’), angry (‘PMS’), or by pursuing

sexual engagements (‘slut’) [1]. Such disciplining

constricts women’s self-attunement and embodied

agency in the world, marks the body as an

uncomfortable site to inhabit.

4.2 Ethnicity-related/racial

stereotypes

Social stereotypes exist in relation to all

dimensions of social location, shaping embodiment.

Patricia Hill Collins [21] described constraining

stereotypes as “controlling images” that work to

limit the possibilities of acting in the world, making

“racism, sexism, poverty, and other forms of social

justice appear to be natural, normal and inevitable

parts of everyday life” (p. 69). In the research

program on embodiment [1], the internalization of

ethnicity-related/racial stereotypes was an

important factor that shaped embodiment. Alice, for

example, the only Aboriginal girl in her mostly White

school in a middle class neighbourhood of a town

with racial-related tensions, felt uncomfortable

being tall since she felt “Like I’m a giant and they’re

afraid of me.” Claire, a woman in her 20s of African-

Canadian heritage, did not feel comfortable

expressing her experienced anger in social situations

where she was subjected to prejudicial treatment as

she was afraid that such expression would, “reaffirm

that we are animals or primitive.” Grace, a woman in

her 50s of African-Canadian heritage, could not

accept her weight, since she feared that being

heavier in weight meant embodying a “subservient”

role.

A critical lens towards social stereotypes is

therefore important to positive embodiment.

5. Privileges and challenges in the social

power and relational connections domain

At the intersection of gender,

ethnicity/race, sexual orientation, social class,

physical disability, and gender identity, social power

affects embodiment in three ways: first, directly,

through regulating the availability of social resources

and, hence, individuals’ living conditions; second,

through subjecting particular individuals to

prejudicial harassment; and, third, through

individuals’ internalization of inequitable and

prejudicial treatment [1]. Inhabiting privileged

bodies assures access to resources (e.g., education,

employment) and freedom from damaging and,

often body-based, harassment, hence facilitating

positive embodied worth. Women experience

gender inequity in multiple domains of their lives,

such as: a gender pay gap, with a greater gap among

women of colour, women heavier in weight, women

living with disabilities [22]; job segregation and ‘glass

ceilings’ in work sites [22]; and inequity in the home

sphere. Poverty rates are consequently higher for

8


women than for men, and more so among women

who are disenfranchised along other varied

dimensions of social location [23]. Related to this

social inequity, women continue to derive social

power from physical appearance, which makes them

vulnerable to pressures regarding body shape.

One way to examine the relationship

between social power and embodiment involves the

study of ‘idealized’ visual representations of women,

since these images comprise a condense way to

reflect and perpetuate cultural values and

prejudices. In a prospective study with girls, ages 10-

18, we asked them to draw themselves, the ideal

girl, and the ideal boy [1]. Ideal girls’ drawings

reflected the disenfranchisement of girls and women

in that ideal girls were both thin and short compared

drawings of the self and the ideal boy, were

objectified and sexualized, wore restrictive and

exposed clothing, and were often denigrated in the

associated narratives (e.g., labelled ‘slut’, ‘dumb

blond’). Yet, idealized images were invariably ‘White’

(blond straight hair, blue eyed, light skin), materially

endowed (brand name clothing, expensive gadgets,

and thin bodies), hetero-sexualized, and perfect (no

allowance for visible differences or disability).

Idealized images of appearance exclude most girls

and women and support body-based harassment

and teasing of girls and women who are heavier, of

colour, poorer, lesbian, bisexual, queer, questioning,

transgender, or live with physical disabilities [1].

Research indeed suggests that a higher number of

different harassment types, increases the adverse

impact on self and body image [24,25].

Positive embodiment therefore relates to

membership in communities of equity and

empowerment, where values of social justice prevail

[1].

6. Moving towards equity

The paper suggests that initiatives that aim

at positive embodiment among girls and women

align with social justice, feminist, anti-oppressive,

and human rights perspectives. All domains of social

experiences outlined by the Developmental Theory

of Embodiment and described in this paper need to

be addressed towards enhanced positive

embodiment among girls and women (see reference

1 for a detailed discussion). In particular, social

transformations need to address the physical lives of

diverse girls and women (e.g., safety, sanctioning of

desire, greater allocation of resources towards girls

and women’s physical activities, equity in pay and in

the distribution of domestic chores). Confining

stereotypes presentations of girls and women

(presented linguistically or visually) should be named

and counteracted at all levels of the social

environment. Similarly, the prejudicial treatment of

diverse girls and women need to be highlighted and

contested at the legal, policy, institutional, media,

and all social forums. Raising consciousness

regarding co-occurring adverse social experiences

diverse girls and women face is crucial. Such

knowledge could propel readers – including scholars,

practitioners, educators, policy makers, and

parents—to take transformative action [1]. Ample

opportunities exist for such initiatives, addressing

physical conditions, social discourses, and access to

sources of social power. Readers can engage in

creative processes of action enriched by their unique

social locations and experiences.

7. References

[1] Piran, N. (2017). Journeys of embodiment at the

intersection of body and culture: The developmental

theory of embodiment. San Diego: CA, Elsevier.

[2] Foucault, M. (1995). Discipline and punish: The birth of

the prison (2nd ed.). New York: Vintage.

[3] Merleau-Ponty, M. (1962). Phenomenology of

perception. New York, NY: Humanities Press.

[4] Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G.,

Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R.

(2011). The National Intimate Partner and Sexual Violence

Survey (NISVS): 2010 Summary Report. Atlanta, GA:

National Center for Injury Prevention and Control, Centers

for Disease Control and Prevention. Retrieved @

https://www.cdc.gov/violenceprevention/pdf/nisvs_repor

t2010-a.pdf

[5] Daniel, J.H. & Dale, S.K. (2013). Women of color:

Violence and trauma. In: B. Greene & L. Comas-Diaz (Eds.),

Psychological Health of Women of Color (pp. 133-146).

Santa Barbara, CA: Praeger.

[6] Garnets, L., Herek, G.M., Levy, B. (1990). Violence and

victimization of lesbians and gay men: Mental health

consequences. Journal of Interpersonal Violence, 5, 366-

383.

[7] Grossman, A.H., & D’Augelli, A.R. (2006). Transgender

youth: Invisible and vulnerable. Journal of Homosexuality,

51 (1), 111-128.

[8] Fine, M., & McClelland, S. (2006). Sexuality education

and desire: Still missing after all these years. Harvard

Educational Review, 76, 297-338.

9


[9] Senne, J. (2016). Examination of gender equity and

female participation in sport. The Sport Journal, 19, 1-10.

[10] Tolman, D. L. (2002). Dilemmas of desire: Teenage

girls talk about sexuality. Cambridge, MA: Harvard

University Press.

[11] Armstrong, E.A., Hamilton, L.T., Armstrong, E.T., &

Seeley, J.L. (2014). “Good girls”: Gender, social class, and

slut discourse on campus. Social Psychology Quarterly, 77,

100-122.

[12] Murnen, S.K., & Smolak, L. (2012). Social

considerations related to adolescent girls’ sexual

empowerment: A response to Lamb and Peterson. Sex

Roles, 66, 725-735.

[23] “Who is poor?” (2016). Institute for Research on

Poverty: University of Wisconsin-Madison.Retrieved from:

http://www.irp.wisc.edu/faqs/faq3.htm

[24] Bucchianeri, M.M., Eisenberg, M.E., Wall, M.M., Piran,

N., Neumark-Sztainer, D. (2014). Multiple Types of

Harassment: Associations with Emotional Well-being and

Unhealthy Behaviors in Adolescents. Journal of Adolescent

Health. 54, 724-729.

[25] Buchanan, N. T., & Ormerod, A. J. (2002). Racialized

sexual harassment in the lives of African American women.

Women & Therapy, 25, 107-124.

[13] Burns, A., Futch, V. A., & Tolman, D. L. (2011). “It’s like

doing homework”: Academic achievement discourse in

adolescent girls’ fellatio narratives. Sexuality Research &

Social Policy: A Journal of the NSRC, 8(3), 239-251.

[14] Gavey, N. (2012). Beyond “empowerment”? Sexuality

in a sexist world. Sex Roles, 66, 718-724.

[15] Bruening, M., MacLehose, R., Loth, K., Story, M.,

Neumark-Sztainer, D. (2012). Feeding a Family in a

Recession: Food Insecurity Among Minnesota Parents.

American Journal of Public Health, 102, 520–526.

[16] Stice, E. (2002). Risk and maintenance factors for

eating pathology: A meta-analytic review. Psychological

Bulletin, 128, 825-848.

[17] Calogero, R.M. (2004). A test of objectification theory:

Effect of the male gaze on appearance concerns in college

women. Psychology of Women Quarterly, 28, 16-21.

[18] Fredrickson, B. L., & Roberts, T. (1997). Objectification

Theory: Toward understanding women’s lived experiences

and mental health risks. Psychology of Women Quarterly,

21,173–206.

[19] McKinley, N. M., & Hyde, J. S. (1996). The objectified

body consciousness scale: Development and validation.

Psychology of Women Quarterly, 20, 181–215.

[20] Tiggemann, M., & Williams, E. (2012). The role of selfobjectification

in disordered eating, depressed mood, and

sexual functioning among women: A comprehensive test

of objectification theory. Psychology of Women Quarterly,

36, 66-75.

[21] Hill Collins, P. (2000). Black feminist thought:

Knowledge, consciousness, and the politics of

empowerment (2nd ed.). New York, NY: Routledge.

[22] “The simple truth about the gender gap pay.” (2016).

American Association of University Women. Retrieved

from:

http://www.aauw.org/files/2016/02/SimpleTruth_Spring2

016.pdf

10


Booty Shorts and Sexting:

A Social Justice Approach to Body Image and Self-Esteem

Dr. Angela Grace, Registered Psychologist

Heart Centered Counselling, Calgary, AB

dr.angela.grace@gmail.com

Abstract

This paper provides parents, educators, and

health care professionals with an overview of how a

social justice approach can inform ways to address

school issues associated with body image and selfesteem.

I present two case studies from my Ph.D.

research that focus on healthy body image and

diversity acceptance in schools to emphasize (1) the

importance of listening to marginalized voices; (2)

how a social justice framework can be used to

identify social justice issues and barriers to a social

justice approach; and (3) how an action plan

addresses issues of social justice and helps to engage

in advocacy efforts.

1. Introduction

Social justice begins with a niggling feeling that

something is ‘not quite right’. In the world of body

image and self-esteem, there are many bothersome

issues that require deeper consideration, such as the

policing of appearance and in school clothing

policies, food shaming in schools, hypersexulization

of girls in media, and fear mongering about

children’s weight. These issues are clearly

bothersome, yet parents, educators, and health care

professionals report feeling powerless to create

effective change. The increasing awareness of

contradictory and biased messages and practices

regarding bodies is a call for social justice. Social

justice examines deeper societal issues of power,

gender, and equality, along with voice and silencing.

It is my hope to provide parents, educators, and

health care professionals with a social justice

framework that gives them the confidence to

effectively address issues of social justice in relation

to body image and self-esteem.

This paper begins with two case studies about

mandatory athletic clothing (booty shorts) and

sexting in junior high school [1]. An overview of

social justice and its link to body image and selfesteem

is provided. I introduce a social justice

framework that emerged from my research that is

aimed at (a) highlighting the importance of listening

to marginalized voices, (b) identifying social justice

issues and (c) creating a plan to address the issues

and engage in advocacy efforts. Finally, barriers to

social justice, such as avoidance, silencing, and

gatekeeping are discussed.

2. Case studies

The following two case studies are from my Ph.D.

research in a non-public school for Grades K-12 in

Alberta, Canada (see Bardick, 2015 for a complete

description of the school and research environment).

Imagine these scenarios:

1. A group of Junior High girls complain about having

to wear “booty shorts” (very short, revealing

shorts) as part of their volleyball uniform, when

the boys could wear comfortable shorts. When

the concern was brought forth to administration,

their response was “that’s what the Olympic team

wears, so that’s what the Junior High girls will

wear.” A number of girls quit the team.

2. A group of Junior High girls complain that a

number of Junior High boys are “sexting” them

(i.e., asking them for topless pictures of

themselves). In response to their concerns, a

female teacher organizes a noon-hour “Girls Club”

where the girls can talk about their feelings.

When I asked administration, “Who is talking to

the boys?”, their response was, “We don’t want to

raise any prickly issues with the parents, so no

one.” Further, administration responded that they

believed these were developmental issues that

were outside of the educational experience, and

students should be dealing with it themselves.

Although these case studies focus on the

experiences of Junior High students, they provide a

foundation for examining how a social justice

perspective can be utilized to identify and address

11


issues of body image and self-esteem. The next

section provides an overview of social justice as a

foundation for this framework.

3. Why social justice?

Social justice may be defined as a lens through

which to examine societal concerns [2]. Social

justice considers how unequal power distributions in

our social structures impact individuals and groups

and helps to identify those with power (i.e.

privileged and dominant groups in our society) and

those without power (i.e. the oppressed and nondominant

groups in our society) [3]. Foundational

understandings of social justice include the

consideration of: (a) equal worth and equal rights,

(b) equal opportunity and ability to meet basic

needs, (c) equal life opportunity, and (d) reduction

and possible elimination of inequities [4]. Social

justice demands fairness and equity in resources,

rights, and treatment [5], and is needed to confront

injustice [6]. In school settings, social justice focuses

on the overall rights and well-being of children,

seeks to remove barriers that inhibit children from

reaching their potential, and seeks to build alliances

(e.g., family-school-community collaborations) [7]. It

involves a commitment to action to speak up for the

rights of children, even when it may be challenging

to do so [8], and address facets of the school

environment that contribute to disrupted

experiences of embodiment, helping students

develop a critical and social justice perspective [9].

3.1 The link between social justice and

body image and self-esteem

A social justice approach calls us to consider how

body image and self-esteem issues are

manifestations of societal expectations. Social

justice has key dimensions of examining physical and

psychological security, resource distribution, and

power relations, and is an emerging framework for

understanding body image and self-esteem.

Applying a lens of social justice to body image and

self-esteem offers a means to shift the focus away

from the individual to broader societal, contextual,

and relationship factors [10]. A social justice lens

provides insights into gendered, relational, and

power experiences that impact people’s relationship

with their bodies [11]. Along with this description of

social justice, an overview of the Developmental

Theory of Embodiment (DTE) [12, 13, 14] provides

further insight into how to consider body image and

self-esteem as social justice issues.

3.2 Developmental theory of

embodiment (DTE)

The DTE developed by Piran [12, 13, 14]) is based

on a 20-year qualitative and quantitative research

program with girls and women. It describes multiple

social processes that affect the way girls and women

feel and live in their bodies. In particular the DTE

describes the way in which a range of physical

experiences, social stereotypes, and structures of

power shape affect embodiment. In this theory,

embodiment is defined as “the experience of

engagement of the body with the world” [15, p.

177]. The DTE describes a continuum of both

positive/connected experiences of embodied agency

(e.g., self-care, attunement with the body) and

disruptions in embodiment (e.g., self-neglect,

restricted agency, and disconnection from the body)

[13, 14]. For example, in the case studies above, the

DTE would identify the girls’ issues with

uncomfortable athletic clothing and sexting as

disrupted experiences of embodiment. The girls’

attempts to express their concerns to administration

would be considered an experience of embodied

agency, as the girls were attuned to their own needs

for safety and self-care. However, not being heard

by administration would further contribute to a

disrupted experience of embodiment, related to

blocked agency and, consequently, embodied

disempowerment.

The DTE asserts that adults and educational

institutions “should provide girls with multiple

opportunities to connect positively with their bodies,

including active and joyful engagement in nonobjectifying

physical activities while wearing

comfortable, non-sexualizing uniforms or clothes”

[12]. In the DTE, Piran [14] emphasized the

importance of (a) encouraging increased connection

with the physical environment, (b) a context that

supports the right for safety and self-care, (c)

guidance regarding bodily changes during puberty,

(d) clearly stated policies against body-based

harassment, and (e) enhancing critical perspectives

on disruptive cultural norms and prejudices [14].

The next section focuses on how a social justice

framework can provide a new lens for addressing

body image and self-esteem concerns.

12


4. Social justice framework

I developed the following social justice

framework as a decision making model to guide

interventions in my clinical practice, with the

following key questions:

1. Who are the marginalized and vulnerable groups

affected?

2. What is the nature of the initial complaint (i.e.,

disrupted experience of embodiment)?

3. What is the nature of the “secret wish” (i.e., a desire

for a positive/connected experience of

embodiment);

4. What is the “problem with the problem”? (i.e., what

does the research say about the issue?)

5. What are evidence-based best practices and possible

solutions?

I use these guiding questions to examine the case

studies from a social justice perspective.

4.1 Listening to marginalized, vulnerable

individuals

Marginalized and vulnerable youth may reach

out for help by identifying issues that may be a

target for intervention from a social justice

perspective. Research has consistently shown that

youth have a lot to say about their experiences with

body-related issues in school settings, and that

students can identify practical and creative ways to

create a healthier environment for all [e.g., 1, 12, 16,

17, 18]. For example, Piran [9] used a feminist

approach to conduct focus groups and provide

support to students in a high-risk ballet school to

help them transform their school environment by

reducing an emphasis on body shape, prohibiting

teachers from making evaluative comments about

body shapes, and introducing a staff member that

students could contact about body shape concerns.

McHugh [17] utilized a participatory action research

(PAR) approach in an Aboriginal girls school that lead

to action initiatives where girls could (a) express

themselves (i.e., Girls Club, focus group, and writing

group), (b) influence school policy (i.e., development

of a school Wellness Policy and hiring of a Wellness

Coordinator), and (c) share their experiences with a

national audience. Fisette [16] described how

accessing girls’ voices can help researchers and PE

teachers develop PE programs that are relevant to

students by identifying barriers that influenced their

participation in and enjoyment of PE classes.

These cases highlight how listening to the voices

of marginalized and vulnerable youth is a powerful

way to access their actual experiences and give them

an opportunity to identify ways to transform their

environment. Listening to marginalized voices may

provide important information to determine if

practices contribute to overall health and well-being

or are potentially causing harm [1]. In light of the

booty shorts and sexting case studies, it is apparent

that the girls were vulnerable, marginalized, and

were asking for their concerns to be heard in order

to create an environment where they felt safe in

their own skin and clothing. A social justice

approach focused on listening to marginalized voices

and lived experiences is a necessary first step in

creating healthy environments.

4.2 The nature of the complaint/secret

wish

From a social justice perspective, the above case

studies exemplify far more than students

“complaining” about things they don’t like. Youth

often make initial complaints about an issue, which

may overlooked by the adults in charge. Hidden

underneath their complaints is a “secret wish” [1], a

term I coined to highlight people’s desire for a

positive outcome. The “secret wish” highlights a

possible avenue for intervention that is driven by

student needs and wants. For example, in the booty

shorts case, the nature of the complaint was wearing

uncomfortable and sexualizing clothing, while their

“secret wish” was the desire to wear athletic

uniforms that are comfortable and non-sexualizing.

By digging deeper than the initial complaint, we can

identify a number of underlying social justice issues

that impacted the girls in this case: (a) gender issues

(i.e., the boys wore long shorts while they were

expected to wear booty shorts), (b) power issues

(i.e., administrators dictated that these were the

uniforms they were required to wear), (c) relational

issues (i.e., they did not want their bodies to be

objectified by boys, and their concerns were not

attended to by administration), and (d) resource

issues (i.e., were the booty shorts their ONLY option

for a uniform? Who was paying for the uniform?).

The secret wish also highlighted a distinct avenue for

intervention – identifying ways the girls could wear

comfortable uniforms. Further, their body image was

initially impacted by wearing revealing booty shorts,

and their self-esteem was impacted by attempting to

advocate for themselves and being silenced through

an administrative “no.”

13


In the case of sexting, the girls’ “secret wish” was

to be treated with respect by the boys, and the boys

“secret wish” was to develop relationships with the

girls. However, their adolescent relational

insecurities combined with an onslaught of social

media messaging about attraction and

hypersexualization, caused their intentions for

relationship to take an ethical and legal turn for the

worse. Although teachers and administration did

hear the girls’ concerns and attempted to create a

Girls Group where the girls could process their

emotions, important gender, power, relational, and

legal issues were not being attended to or resolved.

This case highlighted (a) gender issues (i.e., girls

were identified as being “emotional” and needing a

place to talk about their experiences, while

administrators avoided speaking to the boys who

were perpetrators), (b) power issues (i.e., the boys

had power over the girls by asking for the pictures,

and administration had power over all students), (c)

relational issues (i.e., adolescent relationships were

affected, as were the student-administrator

relationships), and (d) legal issues (i.e., the digital

permanence of sending topless pictures by phone,

and the legal implications of the boys engaging in

harassment and potentially redistributing the

pictures). What could have been a tremendous

learning opportunity for the youth was avoided by

administration due to a fear of raising “prickly”

issues.

We now turn to the question of “what is the

problem with the problem?” in order to provide a

foundation for the social justice framework.

5. What is the problem with the problem?

It is important to turn to the research to identify

“the problem with the problem” to demonstrate

that the concern is valid and problematic within a

broader social context, and to provide a rationale for

evidence-based interventions. For example, in the

booty shorts case, teachers and administration were

aware of the girls expressed discomfort with the

volleyball uniform. However, they did not appear to

be aware of how girls’ discomfort with sport

uniforms impacted their body image, self-esteem,

and enjoyment of sport. Administrator’s response of

“that’s what the professionals wear” minimized how

these issues impacted students’ body image and

reflected how a school sport experience is situated

within a larger sociological context of emulating

professional sports. The “problem with the

problem” in this case is that girls find tight and

exposing clothing problematic, sports’ clothing is an

important facilitator for identity construction and

expression, and fit and comfort are important [19].

Encouraging girls’ participation in sport by having

comfortable uniforms would return their focus to

actual participation in sport, enjoyment, and team

building rather than contributing to unnecessary

discomfort, possible body comparison, and the

potential for dropping out of sport [1].

Examining the research around sexting in

adolescence reflects a complex interaction between

shared risk factors and adolescent sexual and

relationship development. Body-based messages

about how girls “should” look and behave and how

boys “should” talk about female bodies may have a

tremendous impact on students’ body image

satisfaction, self-esteem, and dieting behaviours

[20]. Judge [20] explored the intersection between

the legal and clinical ramifications of sexting, and

outlined the possible motives (i.e., healthy sexual

exploration and self-expression) and harms (i.e.,

pressure to produce sexual images, selfobjectification,

boundary violations, sexual

harassment, emotional distress) of adolescent

sexting. Sexting represents intersections and

tensions with gender, identity, relationship, and

power dynamics combined with typical adolescent

sexual development [20]. Unwanted sexual

comments as a form of harassment are disruptive

experiences of embodiment that have a negative

impact on adolescent self-esteem, and may increase

depressive symptoms, body dissatisfaction,

substance use, eating behaviours, and self-harm

behaviour [9, 12, 21]. The case of sexting moves

beyond individual body image and relationship into

the legal and human rights realm of harassment and

bullying.

With this understanding of the problem, we now

turn to a logical approach to identify solutions and

overcome barriers.

5.1 Identifying solutions

In both case studies, students clearly identified

the problem and their “secret wish” for a more

positive experience, which had the potential to lead

to logical solutions to their initial concerns. For

example, in the case of booty shorts, a logical

solution would be for girls to have an option to

choose a more comfortable athletic uniform to wear

(e.g., wear a matching shirt and comfortable legwear

of their choice). This would require administrative

14


support for the youth to have greater autonomy in

the choice of athletic clothing.

In the case of sexting, there are several steps

required to address the relational, legal and Human

Rights issues associated with sexual harassment. It is

critical that any issue associated with sexual

harassment be taken seriously, as discriminatory

harassment is against the law [24]. Each province

and school board has different legislation and

policies to address issues of sexual harassment, and

these need to be known and adhered to. For

example, in Alberta, the Section 12(g) of the School

Act specifies that “students have a responsibility to

ensure their conduct contributes to welcoming,

caring, respectful and safe learning environments”

[24, p. 12]. In Ontario, a progressive discipline

approach clearly outlines “a continuum of

prevention programs, interventions, supports, and

consequences to address inappropriate student

behaviour and to build upon strategies that promote

and foster positive behaviours” [25, p. 3]. It is

necessary for school administrators to be aware of

their provincial policies and legislation to

comprehensively address issues of sexual

harassment in a manner that is developmentally and

situationally appropriate. In this case, an initial step

would be to have a frank discussion with both the

girls and boys to fully understand the nature of the

sexting and the impact of sexting and consent (both

requesting and sending pictures and sexual

comments) so the students can make a better

informed decision about their actions, improve

communication and relationship, and understand

the potential legal consequences. Further, support

to both those impacted by the event as well as the

perpetrators needs to be provided. Should the

students not follow the recommendations or there

be a repeat occurrence despite intervention and

redirection, further disciplinary and legal action is

necessary to ensure a safe and supportive learning

environment.

Although these possible solutions are logical and

inspired by the students and provincial policy, there

were significant barriers to a social justice approach

that addressed both the human and legal issues

inherent in each case study.

5.2 Barriers to social justice

In both cases, the actual “problem with the

problem” was that the presenting concerns were not

fully attended to by those in a power position (i.e.,

teachers and administration). Barriers to social

justice in these cases include: administrative denial

of issues [22]; administrative censorship [1];

avoidance, silencing and powerlessness [1]; lack of

training and knowledge [1]; lack of time, resources,

school priorities [1]; and not wanting to rock the

boat or raise “prickly” issues [1]. Another important

barrier to a social justice approach is student

reluctance to speak with teachers due to fears of

confidentiality, perceived stigma, and inappropriate

reactions [23], as well as parents being hesitant to

address these issues with administration due to fear

of repercussions from “rocking the boat” [1]. In the

case of sexting, administration’s lack of knowledge

of provincial policy regarding harassment and

relevant disciplinary action was an additional barrier

to social justice.

Silencing and powerlessness occurred when

participants raised an issue that was not in

alignment with school mandates, was not considered

to be a priority, and administration asserted that

neither time nor resources were readily available to

address the issues. Sadly, avoidance, silencing, and

powerlessness in the school context creates a very

unfavourable and disempowering situation for

students. In both cases, there were tremendous

opportunities for the students to be heard and

demonstrate leadership qualities by identifying

logical solutions to bothersome problems. Their

secret wish to create a healthier, empowered,

connected experience of embodiment through a

shared understanding of the need for healthy body

image and self-esteem, was left ungranted.

6. Conclusion

Body image and self-esteem are often

impacted by social justice issues, particularly around

gender, power, relationship, avoidance, and

silencing. A social justice framework can aid in the

quest to listen to marginalized voices, identify areas

of concern (i.e., disrupted experiences of

embodiment), issues of social justice (i.e., gender,

power, relationship), and create logical targets for

intervention. It is my hope that the proposed social

justice framework and the guiding questions

provided can help to: mitigate and repair issues of

social justice that impact body image and selfesteem;

address the need for legal and Human

Rights issues to be seriously considered; and

empower individuals faced with these issues to have

the courage to create meaningful and impactful

change.

15


7. Acknowledgements

Thank you to Dr. Shelly Russell-Mayhew,

University of Calgary, for her supervision of the

research that lead to this publication. Thank you to

Dr. Niva Piran, University of Toronto, for her

contributions to the DTE section of this publication.

Thank you to Mme. Kim Robertson, for advising me

on the Ontario context regarding sexual harassment

in schools.

8. References

[1] Bardick, A. D. (2015). Engaging a school community in a

collaborative approach to healthy body image and

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from http://hdl.handle.net/11023/2292

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counselling: Celebrating the Canadian Mosaic. Calgary, AB:

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[3] Chizhik, E. W., & Chizhik, A. W. (2002). Decoding the

language of social justice: What do "privilege" and

"oppression" really mean? Journal of College Student

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[4] Merrett, C. D. (2004). Social justice: What is it? Why

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doi:10.1080/00221340408978584

[5] Constantine, M. G., Hage., S. M., Kindaichi, M. M., &

Bryant, R. M. (2007). Social justice and multicultural issues:

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6678.2007.tb00440.x

[6] Russell-Mayhew, S. (2007). Eating disorders and obesity

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[7] Shriberg, D., & Desai, P. (2014). Bridging social justice

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N. Piran, & H. B. Ferguson (Eds.), Preventing eating-related

and weight-related disorders: Collaborative research,

advocacy, and policy change (pp. 199-216). Waterloo,

Canada: Wilfred Laurier University Press.

[12] Piran, N., & Teall, T. (2012). The Developmental

Theory of Embodiment. In G. McVey, M. P. Levine, N.

Piran, & H. B. Ferguson (Eds.), Preventing eating-related

and weight-related disorders: Collaborative research,

advocacy, and policy change (pp. 169-198). Waterloo,

Canada: Wilfred Laurier University Press.

[13] Piran, N. (2002). Embodiment: A mosaic of inquiries in

the area of body weight and shape preoccupation. In S.

Abbey (Ed.), Ways of knowing in and through the body:

Diverse perspectives on embodiment (211-214). Welland,

Ontario: Soleil Publishing.

[14] Piran, N. (2017). Journeys of Embodiment at the

Intersection of Body and Culture: The Developmental

Theory of Embodiment. San Diego: CA, Elsevier Press.

[15] Allan, H. T. (2005). Gender and embodiment in

nursing: The role of the female chaperone in the infertility

clinic. Nursing Inquiry, 12, 175-183. doi:10.1111/j.1440-

1800.2005.00275.x

[16] Fisette, J. L. (2013). ‘Are you listening?’: Adolescent

girls voice how they negotiate self-identified barriers to

their success and survival in physical education. Physical

Education & Sport Pedagogy, 18(2) 184-203.

doi:10.1080/17408989.2011.649724

[17] McHugh, T-L. F. (2008). "A new view of body image":

A school-based participatory action research project with

young Aboriginal women (Doctoral dissertation). Retrieved

from ProQuest Dissertations and Theses. (AAT NR62637).

[18] Piran, N. (1999). The reduction of preoccupation with

body weight and shape in schools: A feminist approach. In

N. Piran, M. Levine, & C. Steiner-Adair (Eds.), Preventing

eating disorders: A handbook of interventions and special

challenges (pp. 148-162). Philadelphia, PA: Taylor &

Francis.

[19] Hendley, A. & Bielby, D. D. (2012). Freedom between

the lines: Clothing behavior and identity work among

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young female soccer players. Sport, Education and Society,

17(4), 515-533. doi:10.1080/13573322.2011.608950

[20] Judge, A. M. (2012). “Sexting” among U.S.

adolescents: Psychological and legal perspectives. Harvard

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Piran, N., & Neumark-Sztainer, D. (2014). Multiple types of

harassment: Associations with emotional well-being and

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54(6), 725-729.

[22] Lund, D. E. (2006). Rocking the racism boat: Schoolbased

activists speak out on denial and Avoidance. Race,

Ethnicity

andEducation,9(2),203-221.

doi:10.1080/13613320600696813

[23] Knightsmith, P., Treasure, J., & Schmidt, U. (2014). We

don’t know how to help: an online survey of school staff.

Child and Adolescent Mental Health 19, 208–214.

doi:10.1111/camh.12039

[24] Alberta Government (2016). Guidelines for best

practices: Creating learning environments that respect

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expression. Retrieved from

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attachment-1-guidelines-final.pdf

[25] Ontario Ministry of Eduction [2012]. Policy/Program

memorandum no. 145: Progressive discipline and

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http://www.edu.gov.on.ca/extra/eng/ppm/145.pdf

17


Navigating Differences Within Eating Disorders and “The Other”: What the

Professional Brings and What They Leave Behind

Andrea LaMarre, PhD, Propel Centre for Population Health Impact, University of Waterloo

Kaley Roosen, PhD, Health Psychology Postdoctoral Fellow, The Hospital for Sick Children

(SickKids)

Abstract

Even amongst calls for increased awareness

of eating disorders amongst people with diverse

identities – people of colour, disabled people, etc. –

conversations about eating disorders still carry a

number of assumptions that limit our capacity to

deeply engage with those who struggle. In this

paper, we explore self and other in relation to eating

disorder research and treatment. We invite readers

to engage in critical self-reflexivity around their own

positions, privileges and spaces of belonging as

people who research and treat eating disorders. We

are all implicated in a system that carries with it

potentially problematic relationships with food,

weight, shape, exercise, and diverse bodies. We offer

examples of barriers to compassionate care for

eating disorders and offer a case example with

questions. This paper is a starting point for working

toward more inclusive ways of engaging with

diversely embodied people with eating disorders,

opening space for being with difference, rather than

trying to “fix” it.

1. Introduction

How often are we, as “professionals” in the

eating disorder field, asked to situate ourselves in

the work that we do? Who do we imagine as being a

part of the “we,” and who do we imagine to be a

part of the “them”? Each of us enters into work in

the eating disorders field from different spaces of

belonging. We, the authors, do too. Andrea is a 29-

year-old, white, heterosexual, cis-gender woman in a

cohabiting relationship, middle class and upwardly

socially mobile, who experiences chronic back pain

and identifies as re/covered from an eating disorder.

Kaley is a 33-year-old, white, heterosexual, cisgender,

married, lower-middle class woman, who is

a mother, disabled, chronically ill, and identifies as a

recovered chronic dieter. We offer these opening

thoughts not as a way to evaluate how “biased” or

“unbiased” we might be in writing this, but rather as

a way of beginning to think differently about self and

other in eating disorder research and treatment.

Throughout this paper, we will also encourage you to

situate yourself in relationship to your clients and/or

research participants.

In feminist work, this kind of reflection on your

relationship to what you do and who you work with

is termed reflexivity, which has been used in

research to “dismantle the smokescreen surrounding

the canons of […] impartiality and objectivist

neutrality” [1], p. 81). In the therapeutic context,

reflexivity has been used across therapeutic

paradigms to enhance clinical work—and is about far

more than just naming who we are and what labels

we use [2]. In this vein of deeper reflexivity,

grounded in an understanding of these spaces of

belonging—and how we relate to them and work

through them in daily life, as well as research and/or

therapeutic practice—we use Carla Rice’s [3] critical

self-reflexive approach as a frame for understanding

how looking at our own “embodied subjectivities”

(p. 246). In other words, who we are in our bodies at

a particular moment in time impacts how we

interpret and relate to the experiences of others.

Reflexive practice may come easily to you or may be

more challenging; either way, doing this work is

important for understanding why we do this work

and how we can all do this work in a way that meets

the needs and desires of more people and avoids the

harms caused by un-reflexive working.

2. Othering and Barriers to Eating Disorder

Treatment and Research

We enter into this paper not only with a set of

spaces of social belonging, but also with a stake in

making systems-level change for eating disorders.

Through personal experiences of eating disorders

and disordered eating, from the sides of “patient,”

“provider,” and “researcher,” we have observed how

inaccessible this world—and eating disorder

18


treatment and research—can be for people in

different bodies. Noting these barriers is not a new

proposition; reports of barriers to treatment for

eating disorders have long revealed disturbing

trends, from 86% of ethnically diverse women

seeking treatment for an eating disorder not

receiving care[4], to physicians not noticing eating

disorders in minority [5] disabled [6] and largerbodied

[7] individuals. The world in general, and

healthcare spaces in particular, do not make room

for the lived experiences of people in bodies deemed

different—or “Other”, as we will term it in this

paper, following theorists whose work interrogates

racism, sexism, ableism, and more (e.g.

[8,9,10,11,12,13,14]). We enter into the discussion

of Othering in relation to eating disorders, and how

to move beyond othering and toward embodied

understanding, by asking simply: who is left out of

the conversation about eating disorders?

There is not much imagination in eating disorders

literature and practice for people who experience

food and body related distress and are living with

disabilities, queer, trans, non-binary, racialized, fat,

poor, older, or any configuration of these identities

and/or other marginalized identities [6,15,16]. In

order to understand eating disorders, we have to

understand the contexts in which they arise—and

the ways that heterosexism, ableism, racism,

classism, and other “isms” shape this state of affairs

[17,18,19,20,21]. We need to grasp that who we

assume to be at risk for—and immune to—eating

disorders is fundamentally shaped by socio-political

forces that arrange people into groups of “normal”

and “other” [22,23]. As an example, there is a

dominant stereotype that queer women are immune

to eating disorders because they are assumed to not

be trying to appeal to the male gaze [24,25]. This

stereotype is doubly damaging: it simultaneously

presumes that eating disorders are all about

becoming appealing to men, which has long been

shown to be false [22] and leads to queer women’s

experiences of eating disorders being disproved or

dismissed. Situating this in the larger sociopolitical

landscape, such an assumption is consequential in

light of continued health disparities for LGBTQ+

individuals, including delayed help seeking and

healthcare avoidance [26] linked to stigma and

lacking safety in clinics [27]. Another notable

example is the way in which Black women’s

experiences of eating distress have long been

pushed aside and Othered in white Western medical

models and strains of research [28]. As Becky

Thompson illustrates in A Hunger So Wide and So

Deep, this glossing over reflects a lack of nuanced

understanding of the complexities of food practices

amongst Black women, and how food and food

culture might be navigated differently and in the

context of coping with daily microaggressions. These

are but two examples of how people who experience

marginalization along many and often multiple lines

are “othered” in both eating disorder research and

treatment.

Presumptions of risk and immunity generate

Othering in the eating disorders field, which has

consequences for whose distress is attended to, and

the prescriptions for health offered to people with

eating disorders [16]. For example, research articles

will attempt to “balance” concerns around the

“obesity epidemic” with eating disorder prevention

messages, creating a convoluted set of instructions

about how to be in one’s body for those

experiencing eating disorders of all types at higher

weights [29,30,31]. In clinical practice, healthcare

professionals dismissing eating disorder symptoms

amongst marginalized folks may lead to shame,

healthcare avoidance, and feeling “beyond help”

[6]). This may culminate in medicalized trauma [32]

and isolation for those who are Othered in eating

disorders treatment. Socially, this widespread

ignoring of the experiences of those who do not fit

the expected picture of eating disorders reinforces

stereotypes about eating disorders, creating a

vicious cycle. In turn, we march on with entrenched

models of treatment and modes of research that

may not fit the lived realities of those who desire

help for eating distress. Models of recovery, too, are

painted with a white, thin, able brush, making the

status of recovery feel unattainable for those who

did not fit the expected picture of “legitimately

eating disordered” and thus equally do not fit the

expected picture of recovery [33] [16].

3. An Invitation for Change

We paint this bleak picture not as a way of

engendering defeat or defensiveness. Instead, we

paint this picture as an invitation for change: a

moment to pause and reflect upon the relationship

between these built and long-entrenched

problematics and who we each are as members of

the eating disorders field. This is also an important

moment to consider how we often unintentionally

and despite our best efforts think and act in ways

that shore up these stereotypes. One key concept to

consider as we engage in reflexivity is implicit bias,

or the snap judgments that occur without conscious

19


thought but that drive our attitudes and behaviours,

impacting how we interact in life in general and in

healthcare contexts in particular [34]. While

completely eliminating implicit bias is not a realistic

goal, thinking about how we enact implicit bias and

actively working to challenge it can help us to make

steps toward greater inclusion and equity in care

[35] and in research.

To begin to challenge the biases that pervade the

field and to invite you as readers into this paper, we

offer a case example with a number of questions to

respond to as you explore and assess.

4. Case Example

The following case example is based on a real

individual who participated in a study exploring the

experiences of marginalized persons with disordered

eating [6]. The individual granted permission for this

paper. We will use the pseudonym Robin to refer to

the participant.

Robin is a 29-year-old single woman who was

referred for dietetics services due to issues around

constipation. Robin has cerebral palsy (a neurological

disorder that impacts movement and processing

from birth) and uses an electric wheelchair for

mobility. She lives alone in a supportive housing

apartment where she receives personal attendant

care services for activities of daily living (e.g.,

bathing, cooking, toileting, etc.). Robin currently

receives disability benefits and sometimes struggles

with food insecurity. The original referral did not

indicate weight or height, stating that Robin is

“difficult to weigh due to her disability”. Robin

appears underweight and has stated that she needs

to take eight laxatives daily to help her “remain

regular”. Her food intake is significantly restricted

but she reports that her meals are highly influenced

by her attendant care services. She further explains

that she has limited care hours and sometimes

cannot eat the foods that she wants within her

allotted time. When asked what her goals were,

Robin stated that she wants to learn how she can eat

healthier within her personal circumstances,

including limited support for food preparation and

financial challenges.

In order to examine our inherent biases, it is

important to try and answer the following questions

honestly and quickly, remembering that we are all

products of a culture that values certain bodies over

others. In that spirit, what gut assumptions did you

initially have about Robin? Often, disability is viewed

as a medical problem as opposed to a distinct

marginalized group of people [36]. As a result,

professionals committed to diversity and challenging

cultural biases can often overlook disability [37]. But,

in one study of therapists in training, 95% of

participants viewed disability as a personal tragedy

and responded to disabled clients with feelings of

pity [38]. Certainly, this occurred for Robin. She

explained how she felt many healthcare

professionals working with her simply could not

understand why she would intentionally restrict her

food given that she had so many other health

problems presumed to be associated with her

physical disability. She further explained that there

was a feeling amongst healthcare professionals that

she should not be concerned with her appearance or

size because she, as a disabled woman, was so far

from ever achieving the Westernized beauty “ideal”.

Other gut assumptions that people often associate

with physical disability include feeling sad or sorry

for the individual (Robin recalled feeling like she was

granted “special” permissions out of pity such as

being excused for being late), treating them like a

child (Robin frequently had to remind her care team

to talk to her, not her mother), assumptions around

sexuality (Robin was recently divorced but people

often assumed she was single and asexual), and

assumptions around poverty and social mobility

(Robin was college educated from an upper-middle

class family). Consider which, if any, assumptions

you may have had about Robin. How would these

have impacted your treatment, care or approach

with her?

Next, we would like you to consider what

personal aspects of your identity (e.g., social

location, power and privilege, training experiences,

life experiences) may be at play? For instance, if you

yourself do not have any disability, how might your

privilege as an able-bodied person impact your

interactions? How accessible is your space for

individuals with disabilities? Or, consider typical

solutions recommended to combat restrictive eating:

1) a food diary (Robin is unable to write

independently), 2) finding meaningful movement

(Robin has significant barriers to physical exercise),

3) psychotherapy (Robin has difficulties navigating

inaccessible transportation and office locations), 4)

finding enjoyable food (Robin needs attendant care

services for all of her food preparation), and 5)

reducing/eliminating laxatives and other purging

methods (Robin requires laxatives as part of her

disability symptoms). Perhaps not surprisingly, Robin

spoke about how previous solutions presented to

her by dieticians and physicians often felt out of her

20


each, which contributed to further feelings of

disempowerment and hopelessness. Next, consider

your training. How was disability discussed? In

traditional healthcare professional programs,

disability is usually only discussed as a problem to be

fixed/rehabilitated [39]. For Robin, doctors had

difficulty seeing beyond their typical understanding

of a person with cerebral palsy to understand her

struggles with disordered eating. They offered her

solutions, such as prescription laxatives and pain

management, rather than addressing her eating and

her restriction. Robin recalled that she was never

asked why she wasn’t eating, but rather it was

always assumed to be disability-related. These are

just a few examples of how not checking your own

position and privilege can result in unintended

negative consequences for individuals who

experience marginalization.

Based on your own reflections and previous

experience, what would most likely happen to Robin

if she had sought support for her eating disorder in

your facility or practice? What potential barriers or

challenges might exist? Although Robin was brought

to doctors by her mother on several occasions due

to issues surrounding poor appetite and low weight,

she was not identified as having an eating disorder

for fifteen years! Each time that her low weight was

noted by healthcare professionals, it was explained

away by the fact that many individuals with cerebral

palsy exhibit low body mass indexes. Once identified,

Robin found support of a private psychotherapist

who recommended inpatient treatment. However,

inpatient treatment was grossly inaccessible for her.

She would not have access to her attendant care

services and was uncertain about how she would use

the toilet or transfer in-and-out of bed. Robin also

knew that use of laxatives would not be permitted

on an inpatient unit and she worried about these

consequences. She further reported not wanting to

“feel so different” from all the other individuals

receiving treatment because she needed help with

writing and other tasks. Lastly, consider what needs

to be in place in your facility/practice that could

better to assist Robin. Examples may include

disability-affirmative therapists, policies on

accommodation and more accessible treatment

practices. When treatment guidelines are exclusively

developed with nondisabled individuals in mind,

adapting the treatment later can be difficult and,

sadly, oftentimes impossible. This results in a

withdrawal from services and promotes a selfperpetuating

cycle in which institutions inaccurately

believe that they do not have to adapt their facility

and/or treatment given that marginalized persons

never seek it out.

We hope that this case example provided some

useful content and ideas for reflection. However,

practicing self-reflection and critical reflexivity is an

ongoing, lifelong activity that is only as useful as it

can be regularly implemented. There are a number

of practices that can assist in maintaining the

practice of reflexivity and thereby, encourage

systemic changes in the lives of marginalized

persons. The first, and most important, is to

continually seek out feedback from members of

marginalized groups. This requires active efforts to

remove power differences and barriers that prevent

marginalized persons from participating in systems

of treatment, prevention and research of eating

disorders. It also requires humility to hear feedback

and accept responsibility, particularly for negative

critique. Second, seeking out regular supervision

and/or spaces that allow for vulnerability and

personal exploration can provide space for

reflexivity. This may include seeing a psychotherapist

or finding a mentor, or perhaps inviting other

colleagues to start a reflexivity supervision group.

The structure of said group is less important than the

active engagement in discussion and exploration of

thoughts, feelings, beliefs and behaviours,

particularly those that center discussions around

privilege, systems of oppression, inherent biases and

relational patterns/impacts. A final suggestion is to

engage in regular self-reflection through journaling

or memoing, if it is an accessible option for you.

Although the specific method of self-reflection is not

important, many find the act of regular writing a

helpful tool to put words to their thoughts and

feelings that are often out of active consciousness

(e.g. [40]). Becoming more aware of those automatic

thoughts and feelings are key to breaking inherent

biases related to our work and our lives that we can

acknowledge formed within a toxic (i.e., fatphobic,

ableist, white supremacist [41], heteronormative)

culture.

5. Conclusion

Working through this case example may have

brought up feelings of powerlessness or excitement

for you; there is often a sense of both opening to

new ways of working and an awareness of the

structures that constrain this work that enters into

the room when reflecting on this work. Social justice

work is desperately needed, but very challenging to

practice. Barriers to acting in ways that meet our

21


values include, but are not limited to, funding

limitations, diagnostic requirements, training

demands, ableist work demands, calls for evidencebased

treatment only—and the difficulty of funding

the research required to claim “evidence based.”

Further, we are often constrained by white

supremacist culture, which is characterized by:

perfectionism, sense of urgency, defensiveness,

quantity over quality, worship of the written word,

paternalism, either/or thinking, power hoarding, fear

of open conflict, individualism, progress is bigger,

more, objectivity, and a sense of the right to comfort

[41]. We are not powerless, however. In committing

to this work—to exploring how we other, how we

are othered, and how we might use work on

ourselves and with others to challenge the taken for

granteds in the eating disorder field, we commit to

challenging white supremacist culture. We can work

to understand how privilege infuses the systems in

which we prevent, treat & research eating disorders.

We can consider how the ways we talk about eating

disorders reinforce dominant power structures and

continue to marginalize many. Once we have taken

these steps, we are on our way to actively

challenging stereotypes & acknowledge privilege,

creating space for being with difference.

Reflexivity is not in and of itself enough to

change the pervasive stereotypes and profound

othering in the eating disorders field. To challenge

systemic exclusions, we must also engage

marginalized communities in understanding what

ways of working work for them. As we learn—and

learn how we have and continue to fail, we must

also work to avoid defensiveness. There is a

balancing act to be found between tackling systemic

issues, while providing clients with more immediate

assistance. At its heart, this work entails listening to

and believing—and deeply honouring—various lived

experiences, even when they do not fit our

preconceived ideas about what they might be like.

Challenging systemic exclusions and our own

internal biases is not a “one off”—it is a lifelong,

collaborative, and communal effort. We invite you to

continue this work, and to use this article as a

jumping off point. We offer as concluding thoughts a

number of people who have inspired us in this

journey, whose work you might find helpful in

dismantling systems of oppression: Desirée Adaway,

Sonya Renée Taylor, Virgie Tovar, Be Nourished,

Nalgona Positivity Pride, Marcella Raimondo,

Carmen Cool, Karin Hitselberger and Corbett

O’Toole.

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24


A Weight Neutral Approach to Health and Wellness

Ann McConkey, RD amcconkey@womenshealthclinic.org

Lisa Naylor lnaylor@womenshealthclinic.org

Women’s Health Clinic, Winnipeg, Manitoba

Abstract

Ann McConkey is a Registered Dietitian and

Lisa Naylor is a counsellor in the Provincial Eating

Disorder Prevention and Recovery Program, a

community based program that serves all genders at

an inclusive feminist community health clinic. This

paper provides an overview of the workshop we

delivered at the 2017 National Eating Disorder

Conference. We present a model of care and

practice that addresses physical and mental wellness

for everyone, regardless of body size or current

health status, called Health At Every Size®. As HAES

® practitioners, we are committed to respect,

acceptance and the provision of appropriate care for

people of all shapes and sizes with an emphasis on

health-promoting behaviours and changes to

improve quality of life. We do this with consideration

for emotional, mental, spiritual and physical

wellbeing. This interactive workshop was intended to

share what we have learned about weight neutral

approaches to health and was designed for

educators, counsellors, dietitians, and other medical

care providers to challenge their own assumptions

about weight and health and to learn practical skills

to provide weight neutral health promotion,

education and care.

1. Introduction: Weight neutrality at

Women’s Health Clinic

Women’s Health Clinic (WHC) opened in 1983 in

Winnipeg, MB, Canada. In 1985, Catrina Brown

developed a program at WHC that she later wrote

about with Robyn Zimberg in Consuming Passions:

Feminist Approaches to Weight Preoccupation and

Eating Disorders. This program called, Getting

Beyond Weight, was the first in Canada to recognize

weight preoccupation as a feminist issue,

acknowledge body image and dieting as part of an

eating disorder continuum, and use nonpathologizing

approaches to address eating

disorders [1].

In the 33 years since the initiation of this

trailblazing program, WHC has continued to develop

and deliver numerous programs and educational

initiatives that promote body peace and body equity.

WHC also launched the first community based

treatment program in Manitoba for eating disorders,

which is unique in our weight neutral approach to

recovery. In addition to our eating disorder program,

WHC delivers a wide variety of services (i.e.

counselling, medical, abortion, midwifery, health

education, parenting, etc.) which allows our weight

neutral approach to impact on the health and

wellbeing of thousands of Manitobans.

The Board policy at WHC first reflected weightneutral

values in 1991. Eventually we adopted the

language and principles of the Health At Every Size®

movement culminating in the current WHC Health At

Every Size® Values Statement. To summarize the

values statement: Health at Every Size (HAES)® is an

evidence-based approach to reduce the risk for and

to treat chronic disease. HAES® encompasses

physical, mental, emotional, and spiritual health

while challenging the assumptions about the

relationship between weight and physical health [2].

As HAES® practitioners we commit to promoting:

1. Body Inclusivity

2. Respectful Care

3. Eating for Wellbeing

4. Life-enhancing movement

5. Health enhancement, and

6. Advocacy [2]

These six commitments for our practice provided

the structure for our workshop at the NEDIC

Conference in 2017 and provide the framework for

this paper. This paper outlines our rationale for

utilizing a weight neutral approach, and our method

of implementation. To further explore, we offer

clinical observations from our practice. In addition,

this paper includes reflection questions that were

explored during the workshop to encourage selfreflection

of the reader. Self-reflection is key to

understanding how one’s practice has been shaped

25


y dominant views about weight and health and

instrumental in shifting to a more weight neutral and

weight inclusive approach to practice.

2. Context

2.1 Focusing on weight causes adverse

health outcomes

The medical community and every other industry

related to food and body promote the belief that a

higher body mass index (BMI) is the cause of poor

health; however a growing number of research

studies do not support this viewpoint. A review of

the research by Tylka and colleagues (2014) puts

forward a great deal of evidence that weight control

practices may cause far more adverse health

outcomes than a person’s actual weight. For

instance, Tylka et al (2014) cite studies saying that

when the treatment focused on weight, there was

an increase in weight cycling, binge eating and a

decrease in physical activity [3]. Dieting or focusing

on weight loss has also been found to be a significant

risk factor for developing an eating disorder [4].

2.2 Failure of weight loss interventions

Mann and colleagues (2007) find that dieting is

not effective because there is no known, safe way

for people to lose weight and maintain that loss;

dieting also often leads to weight gain; and most

people tend to end up heavier than they were

before the diet [5].

Weight loss interventions have consistently

shown to fail in the long term, as within 1-5 years

almost all people restore to their original weight and

often gain even more weight [3], [5], [6]. In fact, a

person categorized as having an “obese” BMI has

less than a 1% chance of reaching the “normal”

weight BMI category [6]. The failure of diets is not

due to a lack of individual will power or effort but is,

at least in part, a biological pull to maintain a

consistent body weight [7].

2.3 Why diets don’t work

Our clinical experience finds that restrained

eating creates a sense of deprivation that leads

people to think constantly about food, particularly

foods perceived to be forbidden, such as desserts,

snack foods or fast foods. Many studies have

demonstrated that restriction leads to both

overeating and eating in the absence of hunger and

have shown that binge eating is a natural response

to restrictive eating [3]. This was first demonstrated

in Ancel Keys’ famous 1950 starvation study that

revealed that dietary restriction leads to a

heightened preoccupation with food and eating and

an increase in overeating behaviours [8]. Food

restriction and weight loss negatively impacted

mood and led to an increase in anxiety symptoms

and obsessive thinking [8].

We know that dieting encourages rigid and

controlled behaviour; promotes unhealthy selfesteem,

guilt, shame, depression, and isolation; and

encourages obsessive thoughts and behaviours

regarding food and eating. It further promotes all–

or-nothing thinking, slows metabolism, and

interferes with the body’s natural hunger and satiety

signals. It triggers binge eating and ensures that the

dieter will fail, which often triggers more rigid and

harmful dieting and disordered eating practices.

In summary, depriving one’s body of food and

nutrients by not eating enough causes food cravings

and can lead to binge eating as a natural reaction to

undereating. Subsequent weight gain is due to

metabolic changes, a changed relationship to food,

and the powerful drive of the body to return to its

genetic set point [8].

2.4 Health risks of weight cycling

The failure of dieting often results in repeated

cycles of weight loss and weight gain, known as

weight cycling. A 2005 Finnish epidemiological study

indicated that weight cycling is a risk factor for

cardiovascular diseases. Prevalence of hypertension,

insulin resistance and high cholesterol were found to

be elevated among weight cyclers within the

“normal” BMI category. The study indicated that

even those with a low BMI who weight cycled due to

sport or career (for example: cyclists or ballerinas)

were at risk for chronic diseases commonly

associated with a higher weight [9]. Tylka et al. state

that, “Overall, research conducted around the world

for the past 25 years has repeatedly shown that

weight cycling is inextricably linked to adverse

physical health and psychological well-being” [3],

p.4.

2.5 Dieting on the eating disorder

continuum

Regardless of the specific eating disorder

diagnosis, one factor that we have observed almost

universally with clients in the eating disorder

treatment program is a history of dieting. Multiple

studies have established a causal link between

dieting and binge eating with and without purging. In

a large study of 14–15 year old adolescent girls

26


dieting was the most important predictor of

developing an eating disorder [4]. Those who

engaged in strict dieting practices were eighteen

times more likely to develop an eating disorder

within six months as compared to non-dieters. Girls

who were more moderate dieters were five times

more likely to develop an eating disorder within six

months compared to non-dieters [4]. In another

long-term study with adolescents, some dieters

engaged in more extreme food restriction and

purging or laxative use, while others engaged in

binge eating; additionally, the persistent dieters

showed an increase in body mass index when

compared to the non-dieters [10].

At WHC, all behaviours intended to pursue

weight loss (dieting, over exercising, purging,

restrictive eating, laxative use, and weight loss

surgery) are recognized to exist along a continuum of

disordered eating behaviours. Each behaviour is

associated with different risks that can contribute to

disconnection from the body.

2.6 Weight bias and stigma

Another rationale for weight neutral health care

centres around the reduction of weight bias and

stigma. We know that a focus on weight increases

bias and stigma towards people perceived to be fat.

This may include negative assumptions that are

made about people based on the size of their bodies;

it may include verbal abuse and discriminatory

behaviours. Individuals may experience barriers in

day-to-day life such as undersized chairs in public

locations or a lack of appropriate sized medical

equipment such as blood pressure cuffs or patient

gowns.

Puhl and Heuer (2010) cite multiple studies that

have shown that people are stigmatized because

weight is perceived to be caused by factors within

one’s personal control (11). This serves to justify

stigma as an acceptable societal response [11].

Research on weight bias has found that fat

individuals are less likely to access healthcare and

are less likely to receive evidence-based and biasfree

healthcare when they do access care [12].

Weight bias has also been associated with adverse

health outcomes including anxiety, stress,

depression, and low self-esteem and body image

issues [13]. In addition, the stigma associated with

weight has been further shown to contribute to

social inequities, health disparities and stress

induced illness [11].

Furthermore, specific research on the impact of

weight bias among adolescents indicates that 40-

50% of teens who were teased about their weight

reported feeling depressed and sad [14].

Adolescents also reported coping with weight based

teasing by avoiding activities such as gym class,

increasing food consumption, and binge eating.

Incidents of skipping school and grades dropping

increased along with subsequent experiences of

weight based victimization [14].

Utilizing the framework of weight-neutral care

helps to reduce the weight bias and stigma that is

one of the adverse effects of a focus on weight.

Here are some key questions for personal reflection.

How weight neutral are you? How often do you…

Compliment someone on their weight loss?

Assume someone is doing well because they

have lost weight?

Talk about your weight? Make negative

comments about your size or shape?

Disapprove of body fatness in general?

Equate being fat to being unhealthy?

Say something that assumes others around

you are “watching their weight?”

3. Six Values for Health Promotion

3.1 Body inclusivity

Body inclusivity includes respect for, acceptance

of and provision of appropriate care for people of all

shapes and sizes [2].

Care providers at WHC actively embrace and

appreciate body diversity and strive to respect the

bodies of LGBTQ people, people with disabilities,

disabled bodies, people of colour and Indigenous

people. These inclusive, social justice oriented, and

client centered values are reflected in WHC’s

Principles of Service [15]. Our recommendations for

practicing body inclusivity include:

Respond in a neutral way when someone

reports weight changes but validate positive

health behaviour changes.




Make only positive or neutral comments about

your own body and refrain from commenting on

other’s body shape or size.

Examine your own biases or assumptions about

weight.

Adopt a premise that all bodies are good bodies

and that everyone benefits from feeling

peaceful about their body.

27


For reflection:




What would a body inclusive environment look

like or feel like?

What would be different at your workplace,

classroom, gym, at home or in the community?

How would you deliver service differently?

3.2 Respectful care

The next tenet is respectful care. This means that

all staff have the opportunity to learn about weight

bias, risks of dieting and HAES® principles. The clinic

environment includes chairs and medical equipment

that meet the needs of a wide range of body sizes.

Health education, promotional materials and other

communications use inclusive, diverse images and

non-stigmatizing language when discussing weight or

health [2].

At WHC, we pay attention to the details. For

example, if there are magazines in our waiting room

they will not include messages that are contrary to

our values (i.e. nothing that promotes diets or

weight loss). Another way we practice respectful

care is to avoid stigmatizing language such as

“overweight” or “obese”. These are medical terms

with arbitrarily shifting definitions. In 2013, the

American Medical Association defined “obesity” as a

disease, going against the recommendations of its

own Public Health and Science Committee [16]. The

Canadian Medical Association followed suit in 2015

[17].

At WHC people simply have a weight which is not

used as a measure of their current health status or a

future health goal or expectation. Even with clients

who may be at an artificially low weight due to an

eating disorder, their body shape or size is not

identified as the problem nor as a proxy for the

illness itself. Weight change, in itself, is not seen as

an indicator of restored health and wellbeing.

WHC clients are rarely weighed as this is

unnecessary for most general community health

clinic visits. Weighing may be necessary in

diagnosing specific conditions such as malnutrition

or to prescribe certain medications. We have

observed the adverse effects of weighing which can

include embarrassment, anxiety, and clients

reporting that they avoid seeking medical care.

If weighing cannot be avoided in your practice,

then we suggest you adopt the recommendations

from the Rudd Centre’s on line Tool Kit: Preventing

Weight Bias: Helping Without Harming. This

includes asking for permission to weigh, offering to

have the person face away from the scale and

ensuring that weighing takes place in a private

location and is recorded without comment or

judgement [18].

3.3 Eating for wellbeing

Another important tenant at WHC is to

encourage eating for wellbeing. Healthy eating

includes eating for energy, nutritional needs and

pleasure. We encourage regular eating that is

balanced as well as flexible. Dieting for weight loss is

not recommended [2].

WHC dietitians and other care providers use a

variety of strategies to encourage eating for

wellbeing. We encourage families to share food

together and attempt to make meal times pleasant

and an opportunity for positive connection. Adults

are encouraged to model a balanced relationship

with food, which includes eating regularly and

enjoying all types of foods from all food groups. We

discourage diet talk and labeling food as “good” or

“bad”. In school or community settings, we

discourage food shaming and teaching about food as

“healthy/unhealthy” or “good/bad”. We encourage

educators to teach about nutrition as eating for

energy and pleasure and without connecting it to

weight. In classrooms, children can make soups, visit

a greenhouse, plant and harvest a garden, try new

foods or share traditional dishes made at home.

These activities help children enjoy food and learn

about nutrition without fear of judgment about what

is in their lunch box.

We recognize an important part of eating for

wellbeing includes learning how to nourish the body

adequately and, at the same time, avoid treating

food choice as a moral issue.

People of all shapes and sizes deserve to eat and

be nourished. We encourage clients to eat at regular

intervals and eat enough throughout the day. We

emphasize how this fuels the brain as well as the

body. We use an add in approach when clients are

missing basic nutrients. Even when client goals

include reducing their intake of pop or low-nutrition

snacks, we start with adding in other fluids or the

missing elements such as protein or complex

carbohydrates. Typically, clients begin to make the

desired changes themselves as they notice that they

crave the pop or low-nutrition food less often. No

food is labeled “good” or “bad” as we are also

working towards moving away from all-or-nothing

thinking. Nutritious foods are promoted because

they help to reduce the risk of chronic disease (high

28


lood pressure, diabetes etc.), help with recovery

from discorded eating, improve mood and emotion

regulation, and increase energy levels. Eating foods

that are pleasurable is also encouraged.

Today, food is frequently labeled with a variety of

value-laden words like “clean”, “ethical”, “super” or

“sustainable” which creates a moral divide between

those who strive to eat in a virtuous way versus

those who just eat food. Food that has been

processed in some way prior to consumption is often

perceived as nutritionally inferior and therefore

morally inferior to food prepared at home. The

media and the diet industry reinforce the idea of

“good” and “bad” foods, which even the American

Dietetic Association has stated this may foster

unhealthful eating behaviours [19]. We are aware

that these categories also reinforce other social

distinctions, such as ethnicity, socio-economic status

and education level. We work to decrease shame

about food choices and try to be aware of any food

security issues facing our clients. We normalize

eating and teach that food is more than fuel; it is

also about culture, traditions, experience, pleasure,

and taste.

Clients are encouraged to give themselves

permission to eat all foods. This is done through

education about the futility and risks of dieting,

challenging beliefs that food is an issue of morality,

and providing emotion regulation skills with the goal

of feeling calm. Language around food is neutral.

For example, we may say to a client: You require

regular fueling through the day. You can tune into

your body to notice which type of carbohydrates,

whole grain or white, help you feel more satisfied.

Often people find whole grains more satisfying

because of the fibre.

When people can feel calmer and more relaxed

about eating, and are not labelling their food as

‘good’ or ‘bad’, they are able to eat enough food

regularly through the day and can feel comfortable

integrating a wider variety of foods including treats

and snack foods.

3.4 Life enhancing movement

People of all shapes and sizes are encouraged to

move their bodies in pleasurable ways in order to

enhance their health within the range of their

individual abilities, limitations and interest [2]. At our

clinic, physical activity is promoted for the mental

and physical health benefits, the potential to reduce

the risk of chronic disease, for increased social

connections and for pleasure. Clients are supported

to explore the idea of joyful movement, which we

define as something that gives us pleasure, feels

good in our bodies, and is not punishing or inflexible.

For those with eating disorders, there is considerable

attention paid to what is safe within the context of

recovery.

For personal reflection:

What comes to mind when you think of joyful

movement?

When you are active, are you able to notice if

the activity helps you feel more connected with

your body and your emotions or do you use

activity as a form of disconnection?

3.5 Health enhancement

At WHC, the emphasis is on health-promoting

behaviour changes that improve quality of life and

with consideration for emotional, mental, spiritual,

and physical wellbeing [2].

Rather than focusing on weight, WHC

practitioners discuss health behaviours that may

reduce the risk of chronic diseases [20]. This may

include specific recommendations to: increase

energy, improve blood sugars, and lower blood

pressure and cholesterol etc. In the case of eating

disorders, this includes specific tools for addressing

food and body behaviours. Throughout the

treatment program, clients build skills to ground

themselves, regulate emotions, and practice

mindfulness and self-compassion. In our

observations and client self-assessments, there is

evidence that the practice of these skills, together

with weight neutral messaging, can lead to a

significant reduction in disordered thoughts and

behaviours as well as support long term recovery.

When it comes to health promotion, WHC

addresses messaging to people of all body shapes

and sizes, rather than presume that people with

certain bodies require more health education than

others.

3.6 Advocacy

We promote HAES® principles to our clients,

other health care providers, and the wider health

care system and the community. We promote critical

thought around the damage done due to weight bias

in the fitness, nutrition, healthcare, fashion,

pharmaceutical and diet industries [2]. Advocacy at

WHC extends beyond our weight neutral approach

to other important social issues that impact health.

Poverty, food insecurity, inadequate housing,

29


discrimination based on gender, disability, race or

Indigenous status, along with other social

determinants, such as isolation, are shown to have

significant impact on physiological and psychological

health and wellbeing [21]. WHC attempts to

increase social connection and supports through

support groups, programs that address issues such

as poverty, and/or through prioritizing services to

marginalized communities.

For personal reflection:

What is something you can do to advocate for

inclusion of all shapes and sizes in your

workplace?

If you experience privileges or are awarded

respect based on the size of your body, how can

you use that privilege to support those who are

oppressed or stigmatized based on the size of

their body?

How would the health status of your patients or

clients improve if the social determinants of

health are addressed?

4. Conclusion: Focus on wellness, not

weight

WHC’s decision to focus on wellness not weight

in all aspects of our health care and service delivery

is supported by Tylka et al (2014) [3] and Bacon &

Aphramor’s (2011) [22] review of the empirical

research. Body size is to a large degree genetically

determined [23], [24] and weight is not modifiable

on a sustained basis for most people. Therefore, it is

ethical, responsible, and compassionate to provide

weight neutral care that can actually promote health

behavior change to reduce the risk and treat chronic

diseases.

Specifically within the eating disorder treatment

program, we have observed the therapeutic benefits

that come with our focus on helping clients change

their thoughts, feeling, and behaviours instead of

their weight. This requires preparing clients for the

possibility of body changes during recovery and

acknowledging the grief they may have about weight

change or lack of change in a culture that stigmatizes

bodies that do not conform to societal ideals.

Through cognitive behavioural restructuring and

dialectical behavioural skills such as emotion

regulation, distress tolerance, radical acceptance and

mindfulness, recovery is possible without a focus on

weight change as a measure of success.

In our clinical experience, as clients move

through the eating disorder treatment program, we

have found that clients show a decrease in the

following: disordered food and exercise behaviour:

all or nothing thinking, negative self-talk, isolation,

shame, self-blame, weight preoccupation and

symptoms of anxiety and depression, Many clients

also make improvements to symptoms related to

chronic disease such as lowering their blood

pressure or blood sugar levels. There is also a

measurable increase in self-care and wellnesspromoting

behaviours, body acceptance, selfadvocacy

skills, confidence, and self-worth and selfcompassion.

5. References

[1] Brown, C. and Zimberg, R. (1993). ‘Getting Beyond

Weight’: Women’s Health Clinic Weight Preoccupation

Program. In Brown C. and Jasper, K. (Ed.), Consuming

Passions: Feminist Approaches to Weight Preoccupation

and Eating Disorders Toronto: Second Story Press.

[2] Women’s Health Clinic (2016) Health At Every Size

Values Statement. Retrieved:

http://womenshealthclinic.org/wp-

content/uploads/2018/04/HAES-Value-

Statement.pdf?x88868

[3] Tylka, T. L., Annunziato, R. A., Burgard, D.,

Daníelsdóttir, S., Shuman, E., Davis, C., and Calogero, R. M.

(2014). The Weight-Inclusive versus Weight-Normative

Approach to Health: Evaluating the Evidence for

Prioritizing Well-Being over Weight Loss. Journal of

Obesity, 2014, Article ID 983495.

doi:10.1155/2014/983495

[4] Patton, G. C., Selzer, R., Coffey, C., Carlin, J. B. & Wolfe,

R. (1999). Onset of adolescent eating disorders: population

based cohort study over 3 years. British Medical Journal,

318, 765-768.

[5] Mann, T., Tomiyama, A.J., Westling, E., Lew, A.M.,

Samuels, N. & Chatman, J. (2007). Medicare’s search for

effective obesity treatments: Diets are not the answer.

American Psychologist, 62(3), 220-233. doi:

http://dx.doi.org/10.1037/0003-066X.62.3.220

[6] Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P.,

Prevost, A.T., Gulliford. M.C. (2015). “Probability of an

Obese Person Attaining Normal Body Weight: Cohort

Study Using Electronic Health Records”. American Journal

of Public Health 105:9, 54-59.

[7] Ochner, C. N., Barrios, D. M., Lee, C. D., & Pi-Sunyer, F.

X. (2013). Biological Mechanisms that Promote Weight

Regain Following Weight Loss in Obese Humans.

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Physiology & Behavior, 120, 106–113.

http://doi.org/10.1016/j.physbeh.2013.07.009

[8] Keys, A., Brozek, J., Henschel, A., Mickelsen, O.& Taylor,

H. L.(1950). The Biology of Human Starvation I–II.

Minneapolis, MN: University of Minnesota Press.

[9] Montani, J., Viecelli, A. Prévot, A. & Dulloo, AG. (2006).

Weight cycling during growth and beyond as a risk factor

for later cardiovascular diseases: The 'repeated overshoot'

theory. International Journal of Obesity, 30, S58-66.

10.1038/sj.ijo.0803520

[10] Neumark-Sztainer, D., Wall, M., Story, M., & Standish,

A. R. (2012). Dieting and unhealthy weight control

behaviors during adolescence: Associations with 10-year

changes in body mass index. The Journal of Adolescent

Health : Official Publication of the Society for Adolescent

Medicine, 50(1), 80–86.

http://doi.org/10.1016/j.jadohealth.2011.05.010

[11] Puhl, R. M., & Heuer, C. A. (2010). Obesity Stigma:

Important Considerations for Public Health. American

Journal of Public Health, 100(6), 1019–1028.

http://doi.org/10.2105/AJPH.2009.159491

[12] Lee, J. A., & Pausé, C. J. (2016). Stigma in Practice:

Barriers to Health for Fat Women. Frontiers in

Psychology, 7,

2063. http://doi.org/10.3389/fpsyg.2016.02063

[13] Alberga, A. S., Russell-Mayhew, S., von Ranson, K. M.,

& McLaren, L. (2016). Weight bias: a call to action. Journal

of Eating Disorders, 4, 34. http://doi.org/10.1186/s40337-

016-0112-4

[14] Puhl, R. & Luedicke, J. 2012). Weight based

victimization among adolescents in the school setting:

emotional reactions and coping behaviors. Journal of

Youth And Adolescence, 41(1), 27-40. doi:10.1007/s10964-

011-9713-z.

[15] Women’s Health Clinic (2017) Principles of Service.

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content/uploads/2017/05/Principles-of-Service-Web-

1.pdf?x88868

[16] Stoner, L., Cornwall, J. Did the American Medical

Association make the correct decision classifying obesity as

a disease? (2014). The Australasian Medical Journal; 7(11),

462-464. doi:10.4066/AMJ.2014.2281

[17] Rich P. CMA recognizes obesity as a disease. Retrieved

from https://www.cma.ca/En/Pages/cma-recognizesobesity-as-a-disease.aspx

[18] Rudd Centre for Food Policy and Obesity. Preventing

Weight Bias: Helping Without Harming. Retrieved from

http://biastoolkit.uconnruddcenter.org/

[19] Position of the American Dietetic Association: Total

Diet Approach to Communicating Food and Nutrition

Information. Journal of the American Dietetic Association,

Volume 107, Issue 7, 1224–1232.

[20] Roberts, C.K., Barnard R.J., Effects of exercise and diet

on chronic disease. Journal of Applied Physiology Volume

98, No. 1.

https://doi.org/10.1152/japplphysiol.00852.2004

[21] Mikkonen, J., & Raphael, D. (2010). Social

Determinants of Health: The Canadian Facts. Toronto: York

University School of Health Policy and Management.

Retrieved from

http://www.thecanadianfacts.org/

[22] Bacon, L., Aphramor, L. (2011). Weight Science:

Evaluating the Evidence for a Paradigm Shift. Nutrition

Journal, 10:9. https://doi.org/10.1186/1475-2891-10-9

[23] Stunkard, A.J., Harris, J.R., Pedersen, N.L., McClearn,

G.E. The body‐mass index of twins who have been reared

apart. (1990) New England Journal of Medicine; 322:

1483–1487.

[24] Allison, D., Kaprio, J., Korkeila, M., Koskenvuo, M.M.,

Neale, M.C., & Hayakawa, K. (1996). The heritability of

body mass index among an international sample of

monozygotic twins reared apart. International Journal of

Obesity and Related Metabolic Disorders; 20:6; 501-6.

Retrieved

from

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31


Adolescent girls use power tools: A critical media health literacy program

Joli Scheidler-Benns, York University

Lorayne Robertson, University of Ontario Institute of Technology

Abstract

This paper reports on a media literacy program,

“The Body Positive Program” which was created to

promote protective factors for adolescent girls in the

context of growing concerns around the intersections

of media and health. A critical media health literacy

(CMHL) framework was designed to help explain how

media literacy and health literacy intersect in

important ways for critical studies. The framework

was also used to examine the digital artifacts made

by 26 adolescent girls who attended one four-week,

body-positive program. Participants were

encouraged to think critically about their health and

media for several hours each week. The 26 girls in

the study also participated in a different physical

activity component each week designed to promote

movement and fun rather than emphasize weight or

ability. We anticipated that this emphasis on bodypositive

activities, health, and media literacy would

be reflected in the girls’ designs of their digital

artifacts at the end of the program. We also

interviewed the girls about their artifacts. This paper

reports on one portion of a larger study on this

program. It took place in the fall of 2015 in Ontario

with the cooperation of a non-profit agency that

supports girls in Ontario, Canada.

1. Introduction: Health concerns for

adolescent girls

Many researchers have raised increasing

concerns around adolescent health through a

decline in physical activity e.g., [1], [2] [3]; an

increase in mental health challenges [4]; and a

growth in negative body image issues [5], [6].

Additionally, a recent House of Commons report [7]

suggests that Canadian adolescents are immersed in

a culture that connects acceptance to appearance

and the result is that adolescents may harm

themselves and their health due to body image

concerns. Further, the report also finds that,

although there are biological risks for eating

disorders, the environment can trigger at-risk

outcomes. This trigger can be something such as the

constant monitoring and tracking of food

consumption, measurements of BMI, calorie

counting, or even a compliment directed toward an

aspect of the body. Viewing and internalizing media

messages can also prompt body surveillance and

dissatisfaction. The report suggests that more

research is needed on how to build resilience for

adolescents against this messaging [7].

Societal pressures to look a certain way,

reinforced through media and social media, can

prompt self-esteem issues and increase the

likelihood of mental health challenges, disordered

eating, and poor self-concept based on a body image

ideal that may be unrealistic or impossible for most

adolescent females [8]. Further, there is growing

research that emphasizes that the social

determinants of health play a large role in the health

outcomes for adolescents and their families; these

factors include, for example, household income,

race, ethnicity and gender [9],[10].

2. Adolescent lives

2.1 Media usage

It is undeniable that adolescents are being

exposed to an increasing amount of potentially

harmful media [11],[12]. The media, friends, and

family are the main reasons that adolescent girls

become motivated to change and modify their

bodies [13]. Many adolescent girls misunderstand

body-based media messages and see the messaging

as an encouragement to be thinner, which can entice

them to practice disordered eating such as purging,

restricting food, and using pills and smoking rather

than eating [14].

According to Tiggeman and Slater (2013) internet

exposure and social media are also associated with

the internalization of the thin ideal, body

surveillance, and the drive for thinness even more so

than watching television or looking at fashion

magazines. Additionally, Facebook is also associated

with having a negative body image; Facebook users

scored much higher on every indicator of body

image concerns [15].

32


2.2 Lack of prevention programs

Much of the existing research and health

programming has focused on the idea that individual

choice determines health; this focus ignores the

complexities in our current society [12]. Secondly,

the focus on programs that emphasize exercise and

food as a simple solution is insufficient, not helpful,

could be harmful, and is too narrow of a focus when

a holistic view of health is more supportive. In fact

the Health of Commons (2014) report emphasizes

that the obsession on obesity and its subsequent

policy and societal response supports this limited

direction. Finally, health education may continue to

fail to meet the growing needs of adolescents. Many

interventions blame the individual and further

marginalize people as determined by socioeconomic

status factors [14] which measure a family's social

and economic position in comparison to others,

based on education, occupation, and income levels

[11], [14]. The definition of health is more closely

tied to poverty and issues of marginalization than

whether or not someone made a bad food choice

[10].

The focus of the teaching should not be on the

shape and weight of the student, but rather on

promoting a model of wellness, health, and

resilience along with weight neutral goals [16]. The

House of Commons Report also states that there are

no health and body image prevention programs

geared toward Canadian adolescents; this gap, they

assert, occurs during the riskiest period of

development [7]. The World Health Organization

proposed more holistic approaches to health

(mental, social, and physical) seventy years ago [17].

Currently more than 20 percent of Canadian

adolescents are diagnosed with mental health issues

and media is a factor [4]. Harmful media can

negatively influence self-esteem and body image

[12] and can be more influential than family and

peers [7].

2.2 Potential Protective Factors

Although there are links between media and

several body-image related concerns, there is

another side to media. Using media and

technological tools to combat negative messaging

gives adolescents the platform to fight back by using

their own voices, and is an area that is largely

unexplored [12]. Critical media literacy can give

adolescents the skills to break down media messages

and understand how the idea that acceptance is

related to appearance is a mediated message [18].

The literature surrounding critical media literacy is

only just emerging [17] and very little has been

written about adolescent girls and critical health

literacy. In fact, there is an absolute gap when the

search is critical, health, media and literacy [18].

There is also an absolute gap with respect to the

girls’ voices to deconstruct and reconstruct critical

health literacy messages with the use of media [12].

Building protective factors such as critical media

literacy skills that incorporate ideas around health

and allow adolescents to create body positive

messages can lessen outcomes such as reduced body

dissatisfaction while building resilience [19].

Protective factors such as critical media literacy [18],

critical health literacy [20] and physical activity [21]

can be provided in a prevention program.

By focusing on prevention and protective factors

through the teaching of critical media literacy and

critical health literacy (CMHL) and encouraging

advocacy, this research attempts to fill a gap by

showing that adolescents can build resiliency

through activism [12],[14] [22] and resist unhealthy

media messaging [23].

3. The critical media health literacy

framework

To date media teaching [24] and health teaching

in general [20] have not been at the critical level.

Because these teachings can build protective factors,

this research sought to contribute to the small

amount of literature available on the topic. Nutbeam

theorizes that there are ways to teach students

about health. Programs geared toward health

education and communications have largely failed

and are not adequate, especially within various

social and economic groups within society. At lower

levels of criticality, students are told how to be

healthy. At higher levels, students consider the

evidence and think and act for themselves [20].

This research study set out to explore what

happens when adolescent girls in a course on selfesteem

and body image are encouraged to think

critically about media and their health. We

wondered if this would be reflected in their media

productions. Other questions emerged such as how

their discourse would reflect health understandings.

4. Methodology

The methodology used for the "Body Positive

Program" was qualitative. Elements of data that

were analyzed for the larger study included

observations, interviews with the girls regarding the

33


construction of their media artifacts, and field notes.

This study was conducted over 4 weeks (2 1/2 hours

per week) and included 26 adolescent female

participants ages 12-17. They were invited to

participate through Girls Inc. who were running

programs in the community.

During the last session, the girls were

encouraged to create digital artifacts that could be

used to combat media messaging around body

image. The girls were told that their artifacts would

be on the website www.teachbodyimage.com.

4.1 Critical media health literacy

A framework was developed to measure the

criticality and health levels in the artifacts that the

girls produced. This framework incorporates the

work of several other researchers: Nutbeam’s levels

of health literacy [20], Kellner and Share’s levels of

media literacy [24] and a framework used to

examine the level of criticality in preservice teacher

lessons [25]. It made sense to combine critical

media literacy with health because of the number of

health messages provided in the media, and the

implications of receiving media messages [26]. The

framework used to evaluate the artifacts designed

by the girls in this study is presented in Table 1.

Table 1. Health Literacy/Media Literacy framework

(HL/ML) for artifact evaluation

Levels

Description

Basic media Media that articulates basic

health literacy understandings about health.

Media health Aesthetically pleasing media

arts

about a health issue that

demonstrates basic

understandings of health.

Media health

literacy

Interactive

media health

literacy

Approaching

critical media

health literacy

Critical media

Media uses media conventions to

create a health artifact that

demonstrates the ability to

question basic understandings of

personal health.

Media questions basic

understandings of personal and

social health in way that

communicates more than telling.

Media questions health

information from a political or

social or consumer lens, then

reconstructs and shares the

health message as a way of taking

social or political action.

Media questions health

health literacy information deeply from a

political, social and consumer

lens, then reconstructs and share

the health message as a way of

taking social and political action.

Source: Scheidler-Benns, 2016 [19]

5. Findings

In general, the girls took the topics introduced in

the workshop seriously. They were eager to share

their thoughts and listen attentively to each other.

Often their conversations had to be interrupted in

order to move to the next activity. The discussions

often became lively and many times several girls

were raising their hands at once to share their ideas.

They appeared to feel safe and secure despite the

research team being present, taking notes,

observing, and recording. The girls created six

artifacts during the fourth and final session.

Although all girls were involved in creating the

artifacts, 17 out of the 26 produced artifacts to share

on the website.

5.1 Description of the artifacts

The girls created six artifacts during the fourth

and final session. The choice of media was left up to

the girls and they were free to present their voices in

whatever medium they chose. We asked them to

create something for the website to share.

The first artifact created was a picture of

Soundwave. The toy looks like a robot and contains

many accessories including a photographic memory

from data storage capabilities, shoulder-mounted

rockets, radio wave sensors, and a tape deck. In her

words, the girl described it as a comparison between

a Transformer Soundwave and an average man.

Soundwave is 13 feet, 5 inches and an average guy is

only 5 foot 10 inches. Soundwave’s top speed is

Mach 4.1 and the average guy can move at 14 miles

per hour. She explained that this toy presents a

stereotype that boys have to be tall and strong. She

said that she always thought that girls’ toys were

stereotypical but she had come to realize that boys’

toys were as well. The girl’s interview revealed that

she had chosen this character because she was

concerned that boys were worried about body image

too. She felt that the toy may pressure boys to want

to be a certain size and strength, rather than

embracing their uniqueness. Her message to boys

and girls alike was to not let toys set a guideline for

what size you have to be because there is no toy that

34


matches the unique person you are. She was

passionate about the topic.

The second artifact was the audio of the two girls

singing Try. When asked why they chose the song,

they explained that the song was about accepting

flaws because everyone has them. Words from the

song itself state, “You don’t have to change a single

thing.” They recorded their song publicly in the main

room in an impassioned and powerful way. They

were proud to sing openly in front of the other girls

and this acknowledges their feelings of acceptance.

The third artifact was a six-page PowerPoint

created by five girls entitled Positive Body Image.

They said that it was motivated by a “real” girl who

has had a lot of surgery done to her to look like

Barbie. They were impressed also by the report

about a man who started a foundation for a more

natural doll. The girls said that their slide deck

showed women of different sizes and shapes who

were comparing themselves, and everyone is

different. The slides begin with an image of a

distorted and thin Barbie, a regular Barbie, and the

new Barbie, which is not as tall and thin, showing

uniqueness. The girls said that people think of body

image as a negative idea but that it should be

positive. Their main message was to “Stay positive

and be yourself.”

The fourth group created a 10 slide PowerPoint

entitled, Love Yourself, Accept Yourself. The girls

shared their thoughts about their project by saying

that a person’s own opinion matters the most and

that people should be proud of who they are. People

should not be ashamed of how other people see

them. The girls explained that they wanted to send

the following message to other girls: “Stop the

negative talk about your body. Our differences make

us beautiful. Embrace your unique bodies and love

who you are.” On slide #8 they wrote “Everyone has

a Perfect Body” using pictures of women of many

shapes, sizes and ethnicities. On slide #9 the girls

wrote, “It doesn’t matter; we are all beautiful.”

The fifth group created a video using the song

lyrics and music Words by Hawk Williams. The words

from the song explained the pressures they feel

which are like being a prisoner that needs to be set

free. The girls explained that they chose this song

because, “We’re too hard on ourselves and it's very

hard to draw confidence and you have to do that

from the people around you.”

The sixth artifact was a dance video that three of

the older girls created to the song, Fight Song by

Rachel Platten, and was recorded on an IPad. The

pressures this older group felt were explained in the

lyrics from the song itself. (This is my fight song –

take back my life song.) Their message was that

everyone has different perspectives but all bodies

are beautiful. Another explained that she saw that

no one is built the same and size does not matter.

The artifacts showed that the girls needed very

little support to define their pressures around body

image. They were able to deconstruct and

reconstruct media to change the message. In a very

short amount of the time, all 17 out of the 26 girls

were able produce a media artifact to share on the

website. Although some girls chose to watch other

girls create an artifact, all of the girls participated in

the creation of an artifact during the final evening.

These findings indicate that, when adolescent

girls are encouraged to think critically about their

health and body image, they can do it. The

participants in this study were comfortable and

empowered to use technology to express

themselves using digital tools. They showed

strong facility with technology – almost effortlessly

creating their artifacts using different devices

unassisted. One group used their phone, one group

used the IPad, and the others used laptops or desk

computers, seamlessly moving from discourse to

artifact creation. They were clearly empowered with

the idea of using technology to express themselves.

Their media was socially-focused. They wanted to

use their voices to encourage other girls to not worry

about how they look, to love themselves, to focus on

health not their size, and to continue to share these

messages. Their media showed a sense of their

future audience: other girls who would see these

artifacts on the website. Through their choices of

songs, poems, memes, and images they

acknowledged the pressures and they encouraged

other girls to continue sharing positive messages.

These findings indicate that the media

deconstruction and reconstruction elements

combined in this program are a model that can be

drawn upon for future interventions. Incorporating

these ideas into other prevention methods are

shown here to take very little time to do.

5.2 Findings about health

The participant girls were able to recognize the

potential harm to their health in the media

messages. In listening to their discourse, we found

that the girls saw health through a social lens (being

happy, feeling good). They were powerful

encouragers of each other. They resisted size

comparisons and sought to be comfortable in their

35


own skins. The girls were also very concerned with

mental health, and saw that being supportive, active

and feeling good in general was important. Food was

not discussed.

Within the context of this program, when the

girls talked about health they said it was different

from the way that health is typically taught in

schools. Based on observations, the combination of

health and media literacy teaching provided positive

outcomes. Their enjoyment of the physical activity

and the possible benefits that can be derived from it

during these sessions invites the continuation of

research that combines, rather than separates

physical education, media and health (as is the case

presently in many Ontario schools).

The girls discussed freely and worked on building

community, which may be challenging to do in a

typical school setting, because the girls had much to

say but indicated that they needed safe spaces to do

this. Significantly, the participants indicated that

they sense what is happening in the media but they

needed support with the words and concepts to help

them explain what they were experiencing. They also

relied on strong role models from media to voice

their messages.

6. Conclusions

These findings add to the existing literature in

that the study showed that critical media literacy

combined with critical health literacy can lead to

indications of empowerment and resilience in

adolescent girls. The participants expressed

themselves in a way that showed understanding of

the social construction of beauty and its consumer

links. They felt compelled to share their message

with other girls. This has implication for education

policies to consider adding critical health literacy to

the curriculum as well as more holistic approaches to

health that include social and mental health.

One limitation of this study is that many of the

girls who participated in this program had attended

other aspects of Girls Inc. programs. This is an

organization that inspires girls to be strong, smart,

and bold. They may have had more experience with

positive messaging, thus they may have been more

open to creating strong messaging to share with

other girls. Also, follow up sessions with the girls

would have helped to measure the program benefits

more clearly over time.

7. References

[1] Hobin, E. P., Leatherdale, S. T., Manske, S. R.,

Burkhalter, R., & Woodruff, S. J. (2010). A multilevel

examination of school and student characteristics

associated with physical education class enrollment among

high school students. Journal of School Health, 80(9), 445-

452. doi:10.1111/j.1746-1561.2010.00526

[2] Janssen, I. (2007). Physical activity guidelines for

children and youth. Canadian Journal of Public Health, 98

(Suppl. 2). Applied Physiology, Nutrition, and

Metabolism, 32(S2E), S109-121. doi:S109-121,

10.1139/H07-109

[3] Ntoumanis, N., Pensgaard, A. M., Martin, C., & Pipe, K.

(2004). An idiographic analysis of amotivation in

compulsory school physical education. Journal of Sport and

Exercise Psychology, 26(2), 197-214.

doi:10.1348/135910708X349352

[4] Rawana, J. S., & Morgan, A. S. (2014). Trajectories of

depressive symptoms from adolescence to young

adulthood: the role of self-esteem and body-related

predictors. Journal of Youth and Adolescence, 43(4), 597-

611. doi:10.1007/s10964-013-9995-4

[5] Hausenblas, H. A., & Fallon, E. A. (2006). Exercise and

body image: A meta-analysis. Psychology and Health,

21(1), 33-47. doi:10.1177/1359105309338977

[6] Slater, A., & Tiggemann, M. (2010). “Uncool to do

sport”: A focus group study of adolescent girls’ reasons for

withdrawing from physical activity. Psychology of Sport

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[7] House of Commons. (2014). Eating disorders among

girls and women in Canada: Report of the standing

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[8] Robertson, L. & Thomson, D. (2012). “Be”ing a certain

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37


Learning about Real: Critical Media Literacy and Body Equity

Dr. Lorayne Robertson, University of Ontario Institute of Technology

Abstract

This paper is based on a Critical Media

Literacy workshop presented at the 2017 NEDIC

conference held in Toronto, Canada. The workshop

aligned with the conference themes: awareness,

equity and acceptance. The goals of the workshop

were to promote awareness of the impact of media

culture on children and adolescents; encourage

acceptance of all bodies; and promote body equity.

Research indicates that the school curriculum misses

key opportunities to teach critical media literacy and

body acceptance. With exposure to more critical

forms of literacy, students can learn to recognize and

respond to multiple social media sources showing

stigma and stereotypes, as well as mediated

messages about food and body perfection. The

curriculum should, but does not, address key health

implications of trying to change one’s size and shape.

Through critical media literacy, K-12 students can

learn to ask key questions and remake online content

to counter these hegemonic messages about the

ideal body. They can seek and re-post body-positive

messages and create their own messages to promote

awareness, acceptance and body equity.

1. Introduction

Schools are part of Canadian society, grappling

with both new media and a struggling social

conscience. Critical media literacy is a pedagogy that

brings together new literacy skills and social

awareness. Today’s Canadians have many new ways

to consume and to create media using technology

but they have fewer opportunities to think critically.

They are accustomed to using technology to

communicate. When you hand a smart phone to a

child, invariably they respond by trying to get the

screen to react to their touch. Many privileged

young Canadians who were born by the turn of the

21 st century have never known a world without

colour screens, portable phones, and media that are

social, personalized and responsive. Whether or not

students have opportunities to think critically about

new media is not as apparent, however.

The last 50 years have seen other important,

national changes. A growing form of Canadian social

consciousness is evident in the Charter of Rights and

Freedoms [1]. The Charter prohibits discrimination

based on protected areas such as race, national or

ethnic origin, sex, age or mental or physical ability.

More recently, there has been recognition of the

discriminatory aspects of heteronormativity and the

gender binary; the Canadian Human Rights Act [2]

prohibits discrimination based on the previous

protected areas and adds sexual orientation, gender

identity or expression, marital status, family status,

genetic characteristics, disability, or a pardoned

conviction. Discrimination based on size or shape is

not a protected area under either policy.

The prevention of eating disorders was identified

as a serious health concern by a parliamentary

committee [3] who heard that there is social

pressure on Canadians to conform to an ideal shape

and size. This imperative to look a certain way holds

the individual accountable to make the effort to

achieve an improved body. This narrow focus holds

individuals largely responsible for their health and

ignores the social determinants of health [4],

broader systems of global food provision [5], and

other factors such as genetics that factor into body

size and shape [6] [7]. A focus on individual

responsibility/morality supports a culture of body

shaming. One Canadian psychiatrist reports that

schools can be toxic environments for judging weight

and appearance for girls [3]. There are similar

findings about boys and school [8].

Body equity is a concept that recognizes the

natural diversity of bodies and encourages schools to

acknowledge diverse bodies in its curriculum and

policies [9]. The school curriculum should address

bias based on body size and acknowledge media

pressure to look a certain way. Schools should

consider carefully if they are equating weight and

health, because people can be healthy at many sizes;

slimness is not necessarily an indicator of health. The

curriculum should also introduce students to the

broader health determinants such as differences in

opportunity and access to water, food, and safe

38


spaces to be physically active for Canadians

regardless of their geographic or social location.

2. Canadian Curriculum

It would be very good news, indeed, if we could

report that the curriculum in Canadian schools has

been responsive toward addressing social conscience

and helping students navigate the information age

with a critical stance. Instead, we find that the

Canadian curriculum has been slow to respond in

critical ways. The curriculum has changed little; it

reflects many aspects of the same dominant culture,

class, gender and heteronormativity that has existed

for centuries (See for example [6], [7], [10]).

Herein lies a call to action. We need to update

curriculum policies such as physical education

curricula that reflect long-standing traditions of

military, sport, and the gender binary without

recognition of the natural diversity of bodies, and

different ways to be active, irrespective of ability.

Rather than examining new media for its visual

techniques, which the curriculum presently

promotes, there is a very real need to examine

media in critical ways. One issue might be

considerations surrounding the media diet of

Canadian children. Other issues might include the

commercialization of children’s online spaces.

Canadian students in a wired world need media

studies [11] to understand how sources mediate the

information that students may take for granted as

“truth.” Students need to learn how to ask key

questions to evaluate information and respond

through a more critical lens.

Emergent, ubiquitous technology (new media)

can either perpetuate unhelpful stereotypes, or it

can be used to challenge media representations. The

school curriculum has gaps or is absent in addressing

issues related to the harm perpetuated by media

stereotypes. Talking about these mediated messages

supports the prevention of eating disorders. Body

image and self-esteem curriculum requires a critical

stance. One way to respond to curriculum gaps is to

teach students how to recognize body positive

messages, resist “ideal body” messages, and

construct their own new media to promote the

acceptance of body diversity.

2.1 New literacies, new pedagogies

Students need to participate in selecting,

viewing, and responding to media in ways that allow

them to be more informed and participating citizens.

For this to happen, students need to learn how to

question what is happening in their world and

become critical, reflective kinds of learners. Today’s

issues and politics have significant life or death

implications for certain populations. Globally, there

are shifting changes in populations due to wars and

climate change. Faced with the aftermath of

colonialization, finding peace and reconciliation are

important challenges. There is a growing disparity of

life outcomes for the wealthy and the poor. These

are only some of the challenges facing global

citizens. In order to understand, students will need

to examine why the outcomes of life are different for

different groups and how injustice plays a role in

unequal treatment.

The New London Group designed a pedagogy of

multiple literacies for this new digital era. One

aspect of this pedagogy is the need for overt

instruction on equity concepts [12]. Students need to

understand a meta language that supports the

interrogation and critique of media texts including

negative terms such as oppression, prejudice,

stigma, and discrimination. They also need the words

that will help them to design the future such as

voice, advocacy, fairness and reconciliation.

Sometimes this process involves seeing media

through an historical lens, such as understanding the

impact of the deregulation of children’s television. In

other words, students need to examine issues that

they have previously accepted and taken for

granted, such as explanations about colonialism and

difficult truths about its legacies such as residential

schools. Students also need the skills to examine

advertising that directs them to look a certain way or

media that privileges certain body types. Parents and

teachers can help them to “name” the issues.

2.2 Keeping the “critical” in critical

media literacy

Schools teach media literacy but the curriculum

couches these lessons in neutral tones. For example,

the ministry of education in Ontario says that critical

literacy includes asking students to consider whose

views are represented and whose are omitted [13].

This is promoted without also teaching the broader

social context that there has been a dominant

(white, male, European) influence in school texts

that has presented a mostly singular view of the

world for centuries. Luke describes this as

sidestepping the analysis of social, cultural and

economic power relations [14]. An epistemological

stance of neutrality in education does not

acknowledge the complexity of life and a diversity of

39


views. Teachers who are leaders of inquiry

encourage students to explore multiple perspectives.

The media literacy curriculum informs students

that most media texts are created for profit or

persuasion, but once again, the curriculum fails to

acknowledge that mass media can affect their

overall health choices. Students need the skills to

recognize that media can influence them to change

their bodies and compromise their health in order to

fit into an ideal that is promoted by a cosmetics

company or as fodder for gossip on a talk show.

Rather, the opposite is happening in Canadian

curriculum policy; students are given the message

that they should be working to change and improve

their bodies [7],[10].

The Canadian Women’s Health Network directly

connects media with body dissatisfaction, finding

that media’s perpetuation of the thin ideal leads to

unhealthy dieting, taking drugs to lose weight,

disordered eating, depression, and unnecessary

surgeries such as breast implants. We argue that

students today need age-appropriate lessons that

will help them understand how to investigate and

consider these messages. Students need information

on the broader social contexts in order to

understand the more complex power relations at

work to influence them.

In searching for the best media literacy approach

for a democracy, Kellner and Share examine

curriculum and find four general approaches to

media literacy. The first is the protectionist model,

which cautions against too much screen time or

excessive exposure to media violence. This approach

can be helpful as long as teachers do not

oversimplify it to become anti-media in general. The

second approach is media as art, which examines

the aesthetic elements of media. This can be helpful

if students can use these lessons to create their own

media and find their own voices. The third approach,

media literacy helps students to examine multiple

forms of media but it generally follows the approach

that media are neutral and it does not challenge

taken-for-granted assumptions. A fourth, more

democratic approach, combines elements of the first

three but also involves students in media production

so that they can take action against the social

practices they critique [15].

When combined with critical pedagogy, critical

media literacy requires teachers to 1) examine their

own assumptions; 2) move away from the neutral

space; 3) help students name injustices such as

assumptions of heteronormativity, racism, and

religious intolerance etc.; and 4) encourage the reconstruction

of media and the creation of new

media.

The next section examines how notions of

looking a certain way have resulted in media

perfection codes that coalesce along gender

binaries. Schools can approach these topics using

age-appropriate materials. The body image and

critical media literacy lessons provided at

www.teachbodyimage.com for example, have been

designed with child and adolescent development at

the forefront. These and other well-researched

resources can fill gaps left by curriculum policies that

“sidestep” or take a neutral stance on some of these

issues.

Critical media literacy can help students

understand the broader systems at play impacting

on food choice and food availability. Food choice and

choosing to exercise are not solely the responsibility

of the individual. For example, concepts such as

walkable cities and shorter commutes also

contribute to health. “Choosing” to exercise may be

within the purview of the individual with the means,

the opportunity and the unburdened ability to make

those choices. In this way, the teaching of critical

digital literacies is as important for students’ health

as for its contribution to an informed citizenry.

4. Eating disorder prevention and critical

media literacy

According to multiple leading experts [16], eating

disorders affect an estimated 600,000 to 990,000

Canadians of all ages, with children as young as

seven years old entering eating disorder programs.

More recently, evidence indicates that Canadian

males increasingly experience body dissatisfaction

and disordered eating, along with an unhealthy focus

on gaining muscle. For women aged 15 to 29, one in

four to one in five show symptoms of body

dissatisfaction and disordered eating. As there are

insufficient means to treat all of these individuals,

expert researchers identify that the answer instead

lies in working concertedly on prevention as well as

intervention and treatment [16].

One risk factor for eating disorders that exists in

media is the over-representation of the young, thin

or muscular body shape as the ideal. The prevalence

of this perfect body type can lead someone viewing

media or participating in social media uncritically to

see this body size as the norm, although this body

size occurs naturally in only a small percentage of

the population. Given that most people are younger,

older, taller, shorter, fatter or thinner than this

40


segment of the population, constant comparison

with a mediated ideal contributes to body

dissatisfaction.

Another risk associated with media is the

objectification and sexualization of female bodies to

a large degree but also male bodies. The issue that

needs to be raised is whether or not these media

norms can be accepted uncritically or if they should

be challenged. For example, close-ups focus on a

part of someone’s body, rather than the person and

their message. As Canadians, we have to examine

carefully how comfortable we are with presenting

girls and women so frequently as objects of desire.

There is also the issue of realism, as real life cannot

compete with Photoshop and hours of endless

preparation designed to sell dresses on the red

carpet. Beyond the sale of dresses, these practices

promote what is valued culturally and socially. These

looks are unattainable for the general population.

Presently there is an advertisement on Canadian

television that shows a woman exercising, running a

board meeting and coaching her daughter’s team –

all before breakfast. These types of media messages

subtly tell women how to “be” in the world.

Other media such as gossip shows (talk shows

and entertainment shows) participate blatantly in

social comparison, judging people by their looks and

clothing choices, and assigning popularity.

Acceptance is related to appearance which results in

choices that are risky for health. The results are

profits for those corporate entities focused on selling

weight and appearance management.

One need only look to popular magazines at the

grocery checkout counter to see the inherent

contradictions in the corporate media messages.

While the overall message is to sell, many of the

magazines offer quick weight loss advice as well as

recipes. Commercials sell under the guise that a

person needs to improve their looks to stand up to

social comparison. Many of these ads are aimed at

women and girls (for fuller hair, shinier lips etc.).

Missing from these media messages in general are

realistic body sizes and proportions. Even models

who are selected to represent aging women often do

not have the typical features and proportions of the

women they supposedly represent. Naturally, this

helps to promote the sale of a product to make

someone look younger than their age. These are only

some of the issues.

A key question emerges: Do we want to teach

adolescents to focus on the media techniques and

the audience, or do we want to challenge

adolescents to connect the dots, understand the

powerful forces at work, and participate to create

counter narratives in their (social) media?

The purpose of a critical media literacy program

is to intervene early by reducing the risk factors and

simultaneously building the protective factors such

as peer norms for resilience against harmful

messages. Awareness of eating disorders can help

educators to think about and challenge common

cultural practices that promote body dissatisfaction

such as body shaming or size shaming. One example

of a broader social issue that can be discussed in a

critical media literacy program is the tendency of

people to comment on other people’s size and draw

implications from this about their character. Other

socio-cultural factors include weight-related teasing

and discrimination.

Media are complicit in contributing to body

dissatisfaction by over-representing bodies that do

not reflect average Canadians. Asking students to

think about how bodies are represented in media

can help students see how broader social contexts

shape our views of health and self. Teachers can also

help students see that broader issues such as

geography impact health. This helps to shift the

focus away from health approaches that assign

credit or blame to the individual without considering

the broader social determinants.

The proliferation of new media and the ability of

young people to harness new forms of

communication present a new frontier for eating

disorder prevention, but insufficient attention has

been given to the potential of these new

technologies to advocate for social change [17].

Some of the recommended elements of such a

media literacy program would include awareness of

advertising techniques; naming and countering

gender stereotypes; understanding objectification

and sexualization; considerations of the implicit and

explicit messages of media, and advocating for more

realistic representations of bodies [18].

5. More critical future students

There are some cautions about critical media

literacy and body image intervention programs. One

of the exercises in the critical media literacy

workshop asks participants to compare different

critical media literacy programs and reference

materials for schools. We examine “off the shelf”

lessons for schools that are marketed as critical

media literacy. Participants also assess wellresearched

lessons from the National Eating

Disorders Information Center (NEDIC) curriculum

41


“Beyond Images” which is available free of charge @

http://nedic.ca/beyond-images. According to the

description on the website, Beyond Images is a body

image curriculum created for Grades four through

eight where students explore how and why media

messages are constructed and then learn to

construct their own messages.

Significantly, the workshop participants are not

told the sources of the media lessons up front.

Neither are they given the criteria on which they

should judge the lessons. When they report their

comparisons of these lessons to the full group,

participants’ comments consistently report what

they need in critical media literacy lessons.

First, it is essential that the materials provided

are age-appropriate. Children who are five or six

years old may not grasp some of the messages from

media, but they are old enough to understand, for

example, that advertisements for toys on television

can misrepresent what the toys can do. Children may

not understand the significance of being the target

audience for processed breakfast foods, but they can

learn to use a digital camera and find their voice in

describing the images that they take. Critical media

literacy lessons found at sites such as NEDIC and

www.teachbodyimage.com have been vetted so that

they are age-appropriate and matched to child

development levels.

Workshop participants also examine books that

are available in school libraries that encourage

adolescents to diet or manage their weight in order

to be a certain size. One book talks about the

dangers of being size zero, yet some of the

participants in the workshop are a size zero and they

were born that way. This same book encourages

adolescents to talk to their doctor before they diet

rather than telling students not to diet. Counting

calories and labelling foods as good or bad should

also be discouraged. As health and education

professionals, we have real concerns about the

issues that some of these off-the-shelf curriculum

materials raise. We do not recommend reading

materials for students that equate health with

weight. Instead, we affirm principles of natural

diversity, body acceptance, and equity. In addition,

educators who are concerned that students may

have an eating disorder should refer the student

immediately to a health care professional and should

not address eating disorders with school-based

counselling.

Participants from parent groups, health workers

and others in our workshops have affirmed these

and other central messages that should be apparent

in critical media lessons. Here are some of our

conclusions, posted as key messages on the

www.teachbodyimage.com website.

1. Children and adolescents can understand that

media are not neutral and influence us for

different purposes such as politics and profit.

Advertising uses our insecurities in order to

convince us that we need a product.

2. Teachers/parents can teach and model how to

take apart media messages to examine their

intent and perspective.

3. The ideal body is culturally, socially and

historically defined and media influenced.

4. Media / social media show us only limited views

of the world. Gender stereotypes can contribute

to narrow, sexist ideas and beliefs. Students can

learn that stereotypes limit people from

reaching their potential.

5. Media can misrepresent bodies and accent

gender binaries presenting hyper-sexualized or

hyper-masculinized bodies as the norm. This

can contribute to body dissatisfaction and

harassment.

6. The media can exaggerate health issues and

promote simple solutions for complex issues.

7. Social pressure to be a certain size can be

resisted by empowering students through

critical media literacy studies.

8. We need to discourage social comparison,

especially in light of the present drive to present

perfect images and perfect lives on social media.

9. Everyone can model size and shape acceptance.

10. Teachers and parents can also help by avoiding

linking acceptance to appearance. Source:

www.teachbodyimage.com

Our research has shown that teachers also need to

examine their own biases about shape, size and

dieting [19]. We all need critical media literacy in

what has been called a “post-truth” era. It also

contributes toward eating disorder prevention when

we help students investigate what is “real.”

Acknowledgements: Thank-you to Dr. Dianne

Thomson, Joli Scheidler-Benns, Kalin Moon, Stacey

Taylor and UOIT teacher candidates who created the

www.teachbodyimage.com website.

6. References

[1] Canadian Charter of Rights and Freedoms, s 2, Part I of

the Constitution Act, 1982, being Schedule B to the Canada

42


Act 1982 (UK), 1982, c 11. Retrieved @ http://lawslois.justice.gc.ca/eng/Const/page-15.html

[2] Canadian Human Rights Act. (1985). R.S.C., 1985,c.H-6

Retrieved @ http://laws-lois.justice.gc.ca/eng/acts/h-

6/FullText.html

[3] House of Commons. (2014). Eating disorders among

girls and women in Canada: Report of the standing

committee on the status of women. Canada: Canadian

Government Publications.

http://www.parl.gc.ca/content/hoc/Committee/412/FEW

O/Report s/RP6772133/feworp04/feworp04-e.pdf

[4] Raphael, D. (2009). Social determinants of health:

Canadian perspectives. Toronto, ON: Canadian Scholars’

Press.

[5] Patel, R. (2007). Stuffed and starved: Markets, power

and the hidden battle for the world food system. Black Inc.

[6] Robertson, L. & Scheidler-Benns, J. (2014). Using a

wider lens to shift the discourse on food in Canadian

curriculum policies. Cambridge Journal of Education.

Special Issue: Food, Youth and Education.

http://dx.doi.org/10.1080/0305764X.2015.1091440

[7] Robertson, L. & Thomson, D. (2012). “Be”ing a certain

way: Seeking Body Image in Canadian health and physical

education curriculum policies. Canadian Journal of

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of Education.

[8] Kehler, M., & Atkinson, M. (Eds.). (2010). Boys' bodies:

Speaking the unspoken (Vol. 46). Peter Lang.

[9] Robertson, L. (2014). Body equity – a concept long

overdue. National Eating Disorder Information Centre

Bulletin, 29(4). October, 2015.

[10] Thomson, D., & Robertson, L. (2014). Fit for what?

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[11] Johnson, M. (2014). Life Online: Canadian students

are more connected, more mobile and more social than

ever. Perspectives.(1), 2014.Retrieved @

https://perspectives.ctf-fce.ca/en/article/3032

[12] New London Group. (1996). A pedagogy of

multiliteracies: Designing social futures. Harvard

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[13] Ministry of Education, Ontario (2009). Critical literacy:

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research/Critical_Literacy.pdf

[14] Luke, A. (2018). Critical literacy in Australia: A matter

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(pp. 3-23). New York: Peter Lang.

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disorders: Collaborative Research, Advocacy, and

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[17] Ferrari, M. (2012). Mass Media 2: Advocacy, activism

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w/3597/3008

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